Mo1888 - Infliximab Salvage Therapy in Acute Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

AbstractBackgroundInfliximab is an effective salvage therapy in acute severe ulcerative colitis; however, the optimal dosing strategy is unknown. We performed a systematic review and meta-analysis to examine the impact of infliximab dosage and intensification on colectomy-free survival in acute severe ulcerative colitis.MethodsStudies reporting outcomes of hospitalized steroid-refractory acute severe ulcerative colitis treated with infliximab salvage were identified. Infliximab use was categorized by dose, dose number, and schedule. The primary outcome was colectomy-free survival at 3 months. Pooled proportions and odds ratios with 95% confidence intervals were reported.ResultsForty-one cohorts (n = 2158 cases) were included. Overall colectomy-free survival with infliximab salvage was 79.7% (95% confidence interval [CI], 75.48% to 83.6%) at 3 months and 69.8% (95% CI, 65.7% to 73.7%) at 12 months. Colectomy-free survival at 3 months was superior with 5-mg/kg multiple (≥2) doses compared with single-dose induction (odds ratio [OR], 4.24; 95% CI, 2.44 to 7.36; P < 0.001). However, dose intensification with either high-dose or accelerated strategies was not significantly different to 5-mg/kg standard induction at 3 months (OR, 0.70; 95% CI, 0.39 to 1.27; P = 0.24) despite being utilized in patients with a significantly higher mean C-reactive protein and lower albumin levels.ConclusionsIn acute severe ulcerative colitis, multiple 5-mg/kg infliximab doses are superior to single-dose salvage. Dose-intensified induction outcomes were not significantly different compared to standard induction and were more often used in patients with increased disease severity, which may have confounded the results. This meta-analysis highlights the marked variability in the management of infliximab salvage therapy and the need for further studies to determine the optimal dose strategy.

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Systematic review and meta-analysis of third-line salvage therapy with infliximab or cyclosporine in severe ulcerative colitis

Annals of Gastroenterology ◽

10.20524/aog.2016.0032 ◽

2016 ◽

Cited By ~ 3

Author(s):

Joseph D. Feuerstein

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Salvage Therapy ◽

Meta Analysis ◽

Severe Ulcerative Colitis ◽

Third Line

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P542 Infliximab salvage therapy in acute severe ulcerative colitis: A systematic review and meta-analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx180.669 ◽

2018 ◽

Vol 12 (supplement_1) ◽

pp. S379-S380 ◽

Cited By ~ 1

Author(s):

M C Choy ◽

D Seah ◽

D M Faleck ◽

S C Shah ◽

A Al-Khoury ◽

...

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Salvage Therapy ◽

Meta Analysis ◽

Severe Ulcerative Colitis

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Systematic review and network meta-analysis of treatment for moderate-to-severe ulcerative colitis

International Journal of Clinical Pharmacy ◽

10.1007/s11096-018-0743-4 ◽

2018 ◽

Vol 40 (6) ◽

pp. 1411-1419 ◽

Cited By ~ 12

Author(s):

Cristina Trigo-Vicente ◽

Vicente Gimeno-Ballester ◽

Santiago García-López ◽

Alejandro López-Del Val

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Meta Analysis ◽

Severe Ulcerative Colitis

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Systematic review with network meta-analysis: first- and second-line pharmacotherapy for moderate-severe ulcerative colitis

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.14422 ◽

2017 ◽

Vol 47 (2) ◽

pp. 162-175 ◽

Cited By ~ 81

Author(s):

S. Singh ◽

M. Fumery ◽

W. J. Sandborn ◽

M. H. Murad

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Meta Analysis ◽

Second Line ◽

Severe Ulcerative Colitis

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EFFICACY OF TACROLIMUS FOR INDUCTION OF REMISSION IN PATIENTS WITH MODERATE-TO-SEVERE ULCERATIVE COLITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201700000-15 ◽

2017 ◽

Vol 54 (2) ◽

pp. 167-172 ◽

Cited By ~ 4

Author(s):

Juan LASA ◽

Pablo OLIVERA

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Clinical Response ◽

Clinical Efficacy ◽

Lower Risk ◽

Meta Analysis ◽

Calcineurin Inhibitors ◽

Cochrane Library ◽

Severe Ulcerative Colitis ◽

Risk Of Failure

ABSTRACT BACKGROUND There is evidence that shows that calcineurin inhibitors may be useful for the treatment of severe ulcerative colitis. However, evidence regarding the efficacy of tacrolimus for remission induction in this setting is scarce. OBJECTIVE To develop a systematic review on the existing evidence regarding the clinical efficacy of tacrolimus for the induction of remission in patients with moderate-to-severe ulcerative colitis. METHODS A literature search was undertaken from 1966 to August 2016 using MEDLINE, Embase, LILACS and the Cochrane Library. The following MeSH terms were used: “Inflammatory Bowel Diseases” or “Ulcerative Colitis” and “Calcineurin Inhibitors” or “Tacrolimus” or “FK506”. Studies performed in adult ulcerative colitis patients that evaluated the clinical efficacy of tacrolimus for the induction of remission were considered for revision. A meta-analysis was performed with those included studies that were also placebo-controlled and randomized. Clinical response as well as clinical remission and mucosal healing were evaluated. RESULTS Overall, 755 references were identified, from which 22 studies were finally included. Only two of them were randomized, placebo-controlled trials. A total of 172 patients were evaluated. A significantly lower risk of failure in clinical response was found for tacrolimus versus placebo [RR 0.58 (0.45-0.73)]; moreover, a lower risk of failure in the induction of remission was also found versus placebo [RR 0.91 (0.82-1)]. CONCLUSION Tacrolimus seems to be a valid therapeutic alternative for the induction of remission in patients with moderate-to-severe ulcerative colitis.

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P547 Safety and efficacy of vedolizumab in the treatment of patients with moderate to severe Ulcerative Colitis: a systematic review and meta-analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.668 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S516-S517

Author(s):

M Khorshid Fasge ◽

M Alboraie ◽

W Abbas ◽

Z E Sayed ◽

M El-Nady

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Cohort Studies ◽

Clinical Response ◽

Clinical Remission ◽

Assessment Tool ◽

Meta Analysis ◽

P Value ◽

Severe Ulcerative Colitis ◽

Significant Difference

Abstract Background To perform a systematic review and meta-analysis discussing the efficacy and safety of vedolizumab (VDZ) treatment in patients with active moderate to severe ulcerative colitis (UC). Methods Using relevant keywords, we searched PubMed, Web of Science, Scopus, and Cochrane Central databases, until June 2020. We included interventional and observational cohort studies which assessed the safety and effectiveness of VDZ 300 mg intravenous infusion, in patients with active moderate to severe UC. We used the Cochrane risk of bias assessment tool and the Newcastle-Ottawa scale to assess the quality of included interventional and cohort studies, respectively. Dichotomous outcomes were pooled as proportion, 95% Confidence interval (CI), and p-value under the random-effects model in the open meta-analyst software. Results We found 10 interventional studies and 35 cohort studies, including 4,794 patients eligible for our review. Most of the included citations were single-arm studies. Our meta-analysis showed that VDZ therapy could induce a significant clinical response in UC patients up to 54 weeks (proportion 0.516, 95% CI [0.453, 0.578], p < 0.001). VDZ was associated with clinically significantly clinical remission and steroid-free clinical remission after 54 weeks (p < 0.0001). Durable clinical remission, histological remission, and endoscopic response rates were maintained in UC patients taking VDZ at the 52nd week. There was no significant difference between VDZ and placebo regarding the incidence of drug-related serious adverse events (p = 0.113) and death rates (p = 0.085). Conclusion Our systematic review and meta-analysis showed that the use of VDZ in patients with active moderate to severe UC was associated with high percentages of clinical response and remission rates in induction and maintenance treatment stages. VDZ seems to be well tolerated in UC patients, apart from some infections and inflammations. Future RCTs should compare VDZ to active treatments for longer follow-up periods with larger sample size.

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