Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Inflamm Bowel Dis. 2018 Feb 15;24(3):651-659. doi: 10.1093/ibd/izx039.
Standard outpatient induction dosing of infliximab (IFX) may not be effective in hospitalized ulcerative colitis (UC) patients with higher inflammatory burden and colectomy risk. Our aim was to determine whether initial IFX induction dose affects 30-day colectomy rate and other disease-related outcomes.
IFX-naive hospitalized UC patients receiving at least 1 inpatient 5 mg/kg (SD) or 10 mg/kg (HD) IFX induction dose were included. Baseline demographics and admission-related characteristics were documented. Propensity score based matching was used to control for provider bias introduced due to nonprotocolized choice of IFX dose. The primary outcome was 30-day colectomy; secondary outcomes included the need for an accelerated induction IFX (AD), length of stay (LOS), 90-day and 1-year colectomy, and complications.
Of 146 (120 SD/26 HD) patients included, 25 (17.1%) underwent colectomy by 30 days, 33 (22.6%) by 90 days, and 41 (28.1%) by 1 year. In 21 propensity score matched dyads (n = 42) treated with SD or HD, colectomy rates and LOS were similar. SD patients more often needed AD (23.8% vs. 0%, P = 0.048) and AD patients progressed to colectomy more rapidly within 30 days compared to non-AD (P = 0.001). Female sex and hypoalbuminemia were associated with significantly increased odds of needing AD on both univariate and multivariate analyses.
In our propensity score based analysis, receiving accelerated IFX dosing after an initial SD infusion was associated with significantly higher 30-day colectomy rates in hospitalized acute UC patients. The most effective dosing strategy in this population remains unclear and prospective randomized studies are needed.
标准的门诊诱导剂量英夫利昔单抗（IFX）可能对炎症负担较高且有结肠切除风险的住院溃疡性结肠炎（UC）患者无效。我们的目的是确定初始 IFX 诱导剂量是否会影响 30 天结肠切除率和其他疾病相关结局。
纳入至少接受 1 次住院 5mg/kg（SD）或 10mg/kg（HD）IFX 诱导剂量的 IFX 初治住院 UC 患者。记录基线人口统计学和入院相关特征。采用倾向评分匹配来控制因非方案性选择 IFX 剂量而导致的提供者偏倚。主要结局为 30 天结肠切除；次要结局包括需要加速诱导 IFX（AD）、住院时间（LOS）、90 天和 1 年结肠切除以及并发症。
在 146 例（120 例 SD/26 例 HD）患者中，25 例（17.1%）在 30 天内行结肠切除术，33 例（22.6%）在 90 天内行结肠切除术，41 例（28.1%）在 1 年内行结肠切除术。在 21 对接受 SD 或 HD 治疗的匹配对（n=42）中，结肠切除率和 LOS 相似。SD 患者更常需要 AD（23.8% vs. 0%，P=0.048），AD 患者在 30 天内进展为结肠切除的比例高于非 AD 患者（P=0.001）。单变量和多变量分析均表明，女性和低白蛋白血症与需要 AD 的可能性显著增加相关。
在我们基于倾向评分的分析中，在初始 SD 输注后接受加速 IFX 给药与住院急性 UC 患者的 30 天结肠切除率显著升高相关。在该人群中最有效的给药策略仍不清楚，需要前瞻性随机研究。
