S1897 Characterizing Clinical Outcomes Between Accelerated vs Standard Dose Infliximab in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis

Introduction: Infliximab may be used to treat moderate-to-severe ulcerative colitis (UC). It may also induce remission in patients with acute severe ulcerative colitis. In some cases, a clinician may choose to treat with accelerated induction, with shorter intervals for loading doses and/or with higher doses. This meta-analysis evaluated efficacy and safety of accelerated vs standard dose infliximab, and expands on existing literature by evaluating additional clinical endpoints, including clinical remission, adverse effects, infection rate, and length of hospital stay. Methods: Medline, OVID, and Cochrane Library were searched from inception to 11/30/2024 for randomized clinical trials (RCTs) and retrospective chart reviews reporting the comparison of standard vs accelerated infliximab induction therapy for patients with acute severe ulcerative colitis. Standard dosing was defined as 5 mg/kg with infusions at week 0, 2, and 6 while accelerated dosing was defined as either intensified dosing (greater than 5 mg/kg) or as a shortened induction timeline. We estimated the effect of these 2 treatment strategies by random-effects meta-analyses using the generic inverse variance method. Results were reported as prevalence (%) of outcomes in each treatment group. Lengths of hospital stay was reported in days. Results: Eighteen eligible studies evaluating a total of 2371 patients with severe UC were included (1336 in the standard cohort, and 1022 in the accelerated cohort). Median age was 37 years (interquartile range (IQR): 29-41), and 60% (IQR: 52% to 62%) were men. No significant difference was found in the clinical remission rate when comparing the accelerated (47%; 95% CI: 32% to 63%) and standard dose infliximab cohorts (53%; 95% CI: 39% to 67%). Additionally, there were no significant differences in infection rates (22%; 95% CI: 10% to 42% vs 31%; 95% CI: 23% to 41%), adverse events (18%; 95% CI: 13% to 24% vs 16%; 95% CI: 9% to 28%) or length of hospital stay (14 days vs 13 days) between the cohorts. The risk of bias assessment was moderate. Conclusion: In this systematic review and meta-analysis of RCTs and retrospective chart reviews, patients receiving accelerated dose infliximab did not demonstrate significant differences in efficacy-related outcomes when compared to those receiving standard dosing. However, there were also no significant differences in safety endpoints between these cohorts.