Cyclosporine vs infliximab rescue in ASUC: colectomy

What is known

• A meta-analysis found 3- and 12-month colectomy rates, adverse drug reactions, and postoperative complications equivalent between infliximab and cyclosporine. ¹
• Narrative reviews and a further review conclude both agents are equally effective in steroid-refractory acute severe UC, with rapid response typically within 4-5 days. ^2,3
• Reported 3-month colectomy rates ranged 16.7-40.0% for infliximab and 7.0-63.2% for cyclosporine across the pooled studies. ¹

What is unknown / caveats

• Individual studies diverged: one favored cyclosporine, two favored infliximab, three were equivocal at 3 months ¹
• One retrospective cohort found no 3-month difference (28.5% vs 17%) but a significant 12-month advantage for infliximab (48% vs 17%) ⁴
• Comparative data described as limited and equivocal, largely retrospective/second-line cohorts ¹
• Excerpts do not report numeric pooled short-term rates for a first-line-only population
• Individual study results vary widely even though pooled short-term outcomes are equivalent.

References

1. Chang KH, Burke JP, Coffey JC. Infliximab versus cyclosporine as rescue therapy in acute severe steroid-refractory ulcerative colitis: a systematic review and meta-analysis. Int J Colorectal Dis. 2013;28:287-93. PMID: 23114475.

2. Kumar NS, Khosla R, Makharia GK. Cyclosporine in steroid refractory acute severe colitis. Trop Gastroenterol. 2014;35 Suppl 1:S21-8. PMID: 25735123.

3. Jamal F, Ivanov M, Elmasry S, Gonzalez AJ, Malik TA. Acute Severe Ulcerative Colitis (ASUC): Clinical Features, Initial Management, and the Role of Advanced Therapies. Biomedicines. 2025. PMID: 41153824.

4. Mocciaro F, Renna S, Orlando A, Rizzuto G, Sinagra E, Orlando E, Cottone M. Cyclosporine or infliximab as rescue therapy in severe refractory ulcerative colitis: early and long-term data from a retrospective observational study. J Crohns Colitis. 2012;6:681-6. PMID: 22398101.

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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.