Early infliximab rescue therapy is associated with reduced length of stay in patients with acute severe ulcerative colitis

OBJECTIVES: Patients with acute severe ulcerative colitis (ASUC) inadequately responding to intravenous steroids commonly require rescue therapy, most commonly with infliximab or cyclosporine, traditionally administered on day 3 of admission based on Modified Oxford Criteria. This study aimed to evaluate the impact of early (≤ 72 hours) versus standard (> 72 hours) infliximab administration on different clinical outcomes. METHODS: A retrospective medical records review of patients admitted with ASUC who were administered infliximab rescue therapy due to inadequate steroid response was performed. Patients were divided into 2 groups: early infliximab therapy (≤ 72 hours of admission) and standard infliximab therapy (> 72 hours of admission). Outcomes assessed included length of stay, 12-month readmission and colectomy rates, and infective complications. RESULTS: 84 patients (31 [37%] female, median age 34 [range 29-48.5] years) were included. 31 (37%) received early (median 52 [IQR 45–56] hours) and 53 (63%) had standard (median 105 [IQR 94–149] hours) infliximab therapy, with no significant demographic differences. Median length of stay was shorter in the early vs. standard group at 6 vs. 7 days (p = 0.048). No significant difference was seen in requirement for colectomy at index admission or at 12-months follow up (p > 0.99). Similarly, there was no significant difference in readmission rates at 6- (33.3% vs. 30%, p = 0.76) or 12-months (40% vs. 33.3% p = 0.64). There was no difference in rate of infective complications in the first 30 days. CONCLUSION: Early infliximab therapy was associated with shorter hospitalisation, with no difference in rates of colectomy, re-admission or infective complications.