Infliximab dose-intensified rescue therapy has grown in popularity recently for inpatients with ulcerative colitis. Though these regimens have decreased the colectomy rate, the benefits and risks of prolonged infliximab administration are still hotly contested. The goal of this study was to evaluate the efficacy and safety of dose-intensified infliximab induction therapy compared to the standard induction therapy for severe ulcerative colitis, which consists of 3 doses of 5 mg/kg doses administered at weeks 0 (initiation), 2 (weeks 2 and 4), and 6 (weeks 4 and 6). A historical cohort study was conducted. This research was performed at a large, specialized university hospital. Between 2008 and 2020, 145 adults were treated for ulcerative colitis with inpatient rescue infliximab therapy. Colectomy rates within 3 months of rescue treatment were the primary endpoint. Rates of colectomy at 3 months after starting rescue infliximab, as well as the incidence of perioperative complications in patients who undergo colectomy, are secondary outcomes. Over time, a greater percentage of treatments used a dose-intensified approach. Standard rescue infliximab dosing resulted in a 14% colectomy rate at 3 months, a 16% rate in patients who received a single dose-escalation, and a 24% rate in patients who received multiple inpatient dose-escalations. There was no discernible statistical difference between these rates. Patients who received multiple inpatient doses of dose-escalated therapy during their hospital stay had a higher percentage of colectomy performed during the initial hospitalization and a lower rate of perioperative complications than those who did not. The study’s limited power and the fact that it relied on retrospective data both prevented it from drawing firm conclusions about the true nature of the relationship between the variables of interest. Colectomy rates were not significantly different between patients on the standard treatment plan and those on the dose-intensified plan. Dose-intensified regimens, such as multiple inpatient doses given to patients with more severe diseases, were not linked to a higher risk of perioperative complications.
