The following is a summary of “Efficacy and Safety of Tacrolimus or Infliximab Therapy in Children and Young Adults With Acute Severe Colitis,” published in the August 2023 issue of Pediatrics by Zimmerman, et al.

Acute severe colitis (ASC) in children and young adults can be challenging to manage, and a substantial proportion of patients fail to respond to intravenous corticosteroids. To prevent the need for urgent colectomy in these cases, alternative therapies such as infliximab (IFX) or tacrolimus (TAC) were often used. However, no previous studies compared the outcomes of pediatric patients with ASC treated with either IFX or TAC.

For a retrospective study, researchers found 170 young patients with ASC who had been admitted to our facility and who had not responded to intravenous corticosteroids before receiving either IFX or TAC therapy.  In order to assess different outcomes, they looked at things like 6-month colectomy rates, time to colectomy, improvement in disease activity indices, and negative effects.

The mean age of patients in the IFX group (n = 84) was 14 years, while the mean age in the TAC group (n = 86) was 13.8 years. The median study follow-up time was 23 months. The rate of colectomy 6 months after initiating rescue therapy was similar in both groups, with 22.6% of patients in the IFX group and 26.7% in the TAC group undergoing colectomy (P = 0.53). The mean decline in Pediatric Ulcerative Colitis Activity Index scores from admission to discharge was comparable between patients treated with IFX (31.9) and TAC (29.8) (P = 0.63). While six patients receiving TAC suffered abnormalities in renal function or electrolytes and four patients reported neurologic symptoms, only three patients receiving IFX experienced infusion reactions.

There were no significant differences in the likelihood of colectomy 6 months after initiating IFX or TAC rescue therapy for pediatric patients with ASC who did not respond to intravenous corticosteroids. Both agents showed comparable efficacy. The types of adverse effects differed between the two therapies. The findings supported the use of either TAC or IFX in children with ASC refractory to intravenous corticosteroids.

Source: journals.lww.com/jpgn/Abstract/2023/08000/Efficacy_and_Safety_of_Tacrolimus_or_Infliximab.17.aspx