PDF(Pubmed)
Abstract：
UNASSIGNED: The optimal regimen of infliximab salvage in acute severe ulcerative colitis (ASUC) patients remains controversial. This study aimed to compare accelerated and standard infliximab induction in Chinese ASUC patients, and to explore risk factors and concrete accelerated regimens for them.
UNASSIGNED: Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China. Outcomes including colectomy and clinical remission (Mayo score ≤ 2 and every subscore ≤ 1 at Day 14) rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjustment for potential confounders. The dose-response relationship was explored by plotting restricted cubic splines. Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes. A systematic review and meta-analysis was also performed.
UNASSIGNED: A total of 76 patients were analysed: 29 received standard and 47 received accelerated induction. The accelerated group had a higher 90-day colectomy rate (17.8% vs 0%, P = 0.019) and lower clinical remission rate (27.7% vs 65.5%, P = 0.001). After adjusting for propensity score and institution, there was no significant difference in colectomy or clinical remission rates (both P > 0.05). Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days, with no improvement observed for increasing cumulative infliximab dosage within 28 days. Multivariate logistic regression analyses revealed C-reactive protein of >10 mg/L at infliximab initiation (odds ratio = 5.00, 95% confidence interval: 1.27-24.34) as an independent risk factor for no clinical remission. Meta-analysis also revealed no significant difference in colectomy rates at 3 months (P = 0.54).
UNASSIGNED: After adjusting for confounders, there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASUC patients. Early administration of an intensified dosage within 5 days may be beneficial. Elevated C-reactive protein at infliximab initiation indicated need for intensive treatment.
UNASSIGNED: Data were retrospectively collected from steroid-refractory ASUC patients receiving infliximab as rescue therapy at seven tertiary centers across China. Outcomes including colectomy and clinical remission (Mayo score ≤ 2 and every subscore ≤ 1 at Day 14) rates were compared between patients receiving accelerated and standard infliximab induction using propensity score adjustment for potential confounders. The dose-response relationship was explored by plotting restricted cubic splines. Logistic regression and Cox proportional hazards regression analyses were performed to determine risk factors for adverse outcomes. A systematic review and meta-analysis was also performed.
UNASSIGNED: A total of 76 patients were analysed: 29 received standard and 47 received accelerated induction. The accelerated group had a higher 90-day colectomy rate (17.8% vs 0%, P = 0.019) and lower clinical remission rate (27.7% vs 65.5%, P = 0.001). After adjusting for propensity score and institution, there was no significant difference in colectomy or clinical remission rates (both P > 0.05). Dose-effect curves showed decreased colectomy hazard with higher cumulative infliximab dosage within 5 days, with no improvement observed for increasing cumulative infliximab dosage within 28 days. Multivariate logistic regression analyses revealed C-reactive protein of >10 mg/L at infliximab initiation (odds ratio = 5.00, 95% confidence interval: 1.27-24.34) as an independent risk factor for no clinical remission. Meta-analysis also revealed no significant difference in colectomy rates at 3 months (P = 0.54).
UNASSIGNED: After adjusting for confounders, there were no significant differences in colectomy or clinical remission rates between accelerated and standard infliximab induction among ASUC patients. Early administration of an intensified dosage within 5 days may be beneficial. Elevated C-reactive protein at infliximab initiation indicated need for intensive treatment.
摘要：
■英夫利昔单抗抢救急性重度溃疡性结肠炎（ASUC）患者的最佳方案仍存在争议。这项研究旨在比较中国ASUC患者的加速和标准英夫利昔单抗诱导，并探索危险因素和具体加速方案。
■回顾性地收集了在中国7个三级中心接受英夫利昔单抗作为抢救治疗的激素难治性ASUC患者的数据。在接受加速和标准英夫利昔单抗诱导的患者之间，使用针对潜在混杂因素的倾向评分校正，比较了结果，包括结肠切除术和临床缓解率（Mayo评分≤2，第14天时每个子评分≤1）。通过绘制有限的三次样条来探索剂量-反应关系。进行Logistic回归和Cox比例风险回归分析以确定不良结局的危险因素。还进行了系统评价和荟萃分析。
■共分析了76例患者：29例接受标准诱导，47例接受加速诱导。加速组的90天结肠切除率更高（17.8％vs0％，P=0.019）和较低的临床缓解率（27.7％vs65.5％，P=0.001)。在调整倾向评分和机构后，结肠切除术和临床缓解率差异无统计学意义(均P>0.05)。剂量-效应曲线显示，5天内，英夫利昔单抗累积剂量较高，结肠切除术风险降低，在28天内未观察到增加英夫利昔单抗累积剂量的改善。多变量逻辑回归分析显示，英夫利昔单抗开始时C反应蛋白>10mg/L（比值比=5.00，95％置信区间：1.27-24.34）是无临床缓解的独立危险因素。Meta分析也显示3个月时结肠切除率无显著差异(P=0.54)。
■调整混杂因素后，在ASUC患者中,加速和标准英夫利昔单抗诱导的结肠切除术或临床缓解率无显著差异.在5天内早期给予强化剂量可能是有益的。英夫利昔单抗开始时C反应蛋白升高表明需要强化治疗。
■回顾性地收集了在中国7个三级中心接受英夫利昔单抗作为抢救治疗的激素难治性ASUC患者的数据。在接受加速和标准英夫利昔单抗诱导的患者之间，使用针对潜在混杂因素的倾向评分校正，比较了结果，包括结肠切除术和临床缓解率（Mayo评分≤2，第14天时每个子评分≤1）。通过绘制有限的三次样条来探索剂量-反应关系。进行Logistic回归和Cox比例风险回归分析以确定不良结局的危险因素。还进行了系统评价和荟萃分析。
■共分析了76例患者：29例接受标准诱导，47例接受加速诱导。加速组的90天结肠切除率更高（17.8％vs0％，P=0.019）和较低的临床缓解率（27.7％vs65.5％，P=0.001)。在调整倾向评分和机构后，结肠切除术和临床缓解率差异无统计学意义(均P>0.05)。剂量-效应曲线显示，5天内，英夫利昔单抗累积剂量较高，结肠切除术风险降低，在28天内未观察到增加英夫利昔单抗累积剂量的改善。多变量逻辑回归分析显示，英夫利昔单抗开始时C反应蛋白>10mg/L（比值比=5.00，95％置信区间：1.27-24.34）是无临床缓解的独立危险因素。Meta分析也显示3个月时结肠切除率无显著差异(P=0.54)。
■调整混杂因素后，在ASUC患者中,加速和标准英夫利昔单抗诱导的结肠切除术或临床缓解率无显著差异.在5天内早期给予强化剂量可能是有益的。英夫利昔单抗开始时C反应蛋白升高表明需要强化治疗。
