P467 Systematic Review and Meta-Analysis: Infliximab or Ciclosporin as Rescue Therapy in Patients with Severe Ulcerative Colitis Refractory to Steroids
N. Narula*1, J. Marshall2, J.-F. Colombel1, G.I. Leontiadis2, Z. Maqtadir2, W. Reinisch2
1Mount Sinai Hospital, Gastroenterology, New York, United States, 2McMaster University, Gastroenterology, Hamilton, Canada
Acute severe steroid-refractory ulcerative colitis (UC) carries a poor prognosis and requires optimal management. A systematic review and meta-analysis were conducted to assess ciclosporin and infliximab (IFX) as rescue agents in patients with steroid refractory UC.
A literature search identified studies that investigated IFX and ciclosporin in steroid-refractory ulcerative colitis patients. The primary outcome was short term response to treatment. Secondary outcomes included the rates of colectomy at 3 months and 12 months, adverse drug reactions, postoperative complications in those who received rescue therapy but underwent colectomy subsequently, and mortality. Odds ratios (OR) with 95% confidence intervals (CI) are reported.
Overall, eleven studies with 988 participants were eligible for inclusion. Among two randomized controlled trials with 145 patients, no significant difference was seen with IFX compared to ciclosporin with regards to treatment response, and 3-month or 12-month colectomy. Among non-randomized studies with 843 eligible participants, IFX was associated with significantly higher rates of treatment response (OR 2.99 (95% CI 2.99-4.30)) and lower 12-month colectomy rate (OR 0.38 (95% CI, 0.17-0.85)), with no significant difference seen in 3 month colectomy rate (OR 0.71 (95% CI, 0.26-1.89) compared to ciclosporin. There was no significant difference between IFX and ciclosporin in adverse drug-related events, postoperative complications, or mortality.
In the management of steroid refractory severe UC, no definitive preference between IFX and ciclosporin exists based on randomized trials, but non-randomized studies suggest IFX is associated with better treatment response and lower risk of colectomy at 12 months.