S1724 Clinical Outcomes of Intensified vs Standard Infliximab Induction in Acute Severe Ulcerative Colitis: A Meta-Analysis

Introduction: Acute Severe Ulcerative Colitis (ASUC) requires prompt escalation of care in steroid-refractory patients. Infliximab, a TNF-α inhibitor, is commonly employed as rescue therapy, yet its standard induction dosing may be inadequate due to high inflammatory burden and increased fecal drug loss. Accelerated induction either through higher initial doses or shorter intervals aims to overcome these pharmacokinetic challenges. The clinical benefit of such approaches, however, remains controversial. In this study, we evaluated whether accelerated infliximab induction reduces short and long-term colectomy rates compared to standard induction in hospitalized patients with steroid-refractory ASUC. Methods: We conducted a meta-analysis of 7 studies, examining accelerated vs standard IFX induction in ASUC were included. Data were extracted on sample size, induction strategy, colectomy outcomes, and other significant findings. Standard induction was defined as 5 mg/kg at 0, 2, 6 weeks. Accelerated regimens varied: some used upfront 10 mg/kg while, others administered multiple doses within 7–10 days. Results: We analyzed 7 studies (n = 713), comparing accelerated induction of infliximab (IFX) vs standard induction in ASUC. The primary outcome was the incidence of colectomy within 90 days of treatment initiation. In 2 of the studies, we observed significant reductions in the need for colectomy with intensive therapy. Specifically, Gibson et al reported a colectomy rate of 6.7% vs 40% (OR 0.11, 95% CI 0.02–0.58) and Sebastian et al.: 27% vs 57% (OR 0.28, 95% CI 0.13–0.60) for intensified vs standard therapy. However, additional studies did not show any significant differences between the groups. When the results were pooled, the Fixed Effects model yielded an OR of 0.62 (95% CI, 0.41–0.94) while the Random Effects model produced an OR of 0.65 (95% CI, 0.31–1.38). Conclusion: Accelerated or intensified IFX regimens may reduce short term colectomy risk in ASUC, particularly in select subgroups. Benefits were most evident in studies with structured protocols and early outcome assessment. However, variability across studies limits generalizability. Most were retrospective, with inconsistent ASUC definitions and limited safety data. The random-effects model did not reach statistical significance, emphasizing the need for cautious interpretation. Overall, intensified IFX may be beneficial in high-risk patients, but randomized trials are needed to confirm efficacy and guide clinical practice.