Comparison of accelerated and standard infliximab induction regimens in acute severe ulcerative colitis using propensity score analysis:a retrospective multicenter study in China  

作　　者：Xinyu Liu Hui Li Feng Tian Ying Xie Xiaoqi Zhang Min Zhi Min Zhang Xiaomei Song Hong Guo Xiaofei Li Jie Liang Jun Shen Yue Li 

机构地区：[1]Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing,P.R.China [2]Eight-Year Medical Doctor Program,Chinese Academy of Medical Science&Peking Union Medical College,Beijing,P.R.China [3]Department of Gastroenterology,Shengjing Hospital of China Medical University,Shenyang,Liaoning,P.R.China [4]Department of Gastroenterology,Nanjing Drum Tower Hospital,School of Medicine,Nanjing University,Nanjing,Jiangsu,P.R.China [5]Department of Gastroenterology,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong,P.R.China [6]Department of Gastroenterology,Chongqing General Hospital,Chongqing,P.R.China [7]Department of Gastroenterology,Xijing Hospital of Digestive Diseases&State Key Laboratory of Cancer Biology,Fourth Military Medical University,Xi’an,Shaanxi,P.R.China [8]Department of Gastroenterology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,P.R.China

出　　处：《Gastroenterology Report》2024年第1期279-288,共10页胃肠病学报道(英文)

基　　金：supported by National High Level Hospital Clinical Research Funding[grant number 2022-PUMCH-B-022];CAMS Innovation Fund for Medical Sciences(CIFMS)from Chinese Academy of Medical Sciences[grant number 2021-I2M-1-062].

摘　　要：Background:The optimal regimen of infliximab salvage in acute severe ulcerative colitis(ASUC)patients remains controversial.This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC patients,and to explore risk factors and concrete accelerated regimens for them.Methods:Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China.Outcomes including colectomy and clinical remission(Mayo score≤2 and every subscore≤1 at Day 14)rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjust-ment for potential confounders.The dose-response relationship was explored by plotting restricted cubic splines.Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes.A systematic re-view and meta-analysis was also performed.Results:A total of 76 patients were analysed:29 received standard and 47 received accelerated induction.The accelerated group had a higher 90-day colectomy rate(17.8%vs 0%,P=0.019)and lower clinical remission rate(27.7%vs 65.5%,P=0.001).After adjust-ing for propensity score and institution,there was no significant difference in colectomy or clinical remission rates(both P>0.05).Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days,with no improve-ment observed for increasing cumulative infliximab dosage within 28 days.Multivariate logistic regression analyses revealed C-reac-tive protein of>10 mg/L at infliximab initiation(odds ratio?5.00,95%confidence interval:1.27-24.34)as an independent risk factor for no clinical remission.Meta-analysis also revealed no significant difference in colectomy rates at 3 months(P=0.54).Conclusions:After adjusting for confounders,there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASU

关 键 词：acute severe ulcerative colitis INFLIXIMAB accelerated induction propensity score analysis 

分 类 号：R574.62[医药卫生—消化系统]