Hospitalized ASUC: infliximab or cyclosporine

What is known

• Meta-analysis found comparable long-term outcomes for cyclosporine and infliximab in steroid-refractory acute severe UC. ¹
• Following initial response to cyclosporine, about 50% of patients avoid colectomy at three years, with lower rates on longer follow-up. ^2,3
• A small placebo-controlled trial showed infliximab reduced colectomy at three months versus placebo in steroid-refractory disease. ^2,3
• Both agents carry increased risk of serious opportunistic infections; cyclosporine contraindications include renal insufficiency, infection, hypocholesterolemia, hypertension. ^3,4

What is unknown / caveats

• Some data suggest cyclosporine-treated patients with more severe endoscopic lesions are at increased colectomy risk
• Much comparative data is retrospective and single-center
• Excerpts note initial reports of increased postoperative septic complications with infliximab but do not resolve this
• The excerpts do not establish one agent as superior for initial rescue therapy.

References

1. Szemes K, Soós A, Hegyi P, Farkas N, Erős A, Erőss B, Mezősi E, Szakács Z, Márta K, Sarlós P. Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis. Front Med (Lausanne). 2019;6:338. PMID: 32039218.

2. Van Assche G, Vermeire S, Rutgeerts P. Treatment of severe steroid refractory ulcerative colitis. World J Gastroenterol. 2008;14:5508-11. PMID: 18810767.

3. Van Assche G, Vermeire S, Rutgeerts P. Management of acute severe ulcerative colitis. Gut. 2011;60:130-3. PMID: 21030524.

4. Pola S, Patel D, Ramamoorthy S, McLemore E, Fahmy M, Rivera-Nieves J, Chang JT, Evans E, Docherty M, Talamini M, Sandborn WJ. Strategies for the care of adults hospitalized for active ulcerative colitis. Clin Gastroenterol Hepatol. 2012;10:1315-1325.e4. PMID: 22835577.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.