P0771 Early Infliximab Rescue therapy is associated with reduced length of stay in patients with acute severe ulcerative colitis

Background

Acute severe ulcerative colitis (ASUC) represents a medical emergency necessitating admission and prompt commencement of intravenous steroids. Up to 40% of patients may require rescue therapy with infliximab, traditionally administered on day 3 of admission based on the Modified Oxford Criteria. This study aimed to evaluate the impact of early (≤ 72 hours) versus standard (> 72 hours) infliximab administration on clinical outcomes.

Methods

A single centre retrospective cohort study was conducted for patients admitted with ASUC as defined by the Truelove and Witt’s criteria who received infliximab therapy between January 2016 and October 2024. Patients were divided into 2 groups: early infliximab therapy (≤ 72 hours of admission) and standard infliximab therapy (>72hrs of admission). Patient demographics and disease characteristics were accessed from the electronic medical records (EMR). Outcomes assessed included length of stay, 12-month readmission and colectomy rates.

Results

84 patients (53% male, 37% female) were included in this study. Of these 31/84, (37%) received early infliximab therapy (median 52 [IQR 45-56] hours) and 53/84 (63%) had standard (median 105 [IQR 94-149] hours) infliximab therapy. Disease characteristics are shown in table 1. Mean albumin on admission was higher in the early infliximab group (36g/L vs 32.5g/L, p= 0.01). No other significant differences were noted.

The median length of stay was shorter in patients who received early vs standard infliximab therapy at 6 vs 7 days (p= 0.048). No significant difference was seen in requirement for colectomy between the early and standard groups at index admission (3.2% vs 3.8%, (p = 1.0) or at 12-months follow up (6.6% vs 6.9%, (p = 1.0). Similarly, there was no significant difference in readmission rates at 6-months (33.3% vs 26%, p= 0.67) and at 12-months (40% vs 28.8% p= 0.63) for both ulcerative colitis-related and non-ulcerative colitis causes across the two groups. There was no difference in rate of infective complications in the first 30 days (6.4% vs 7.5%, p = 0.85).

A propensity matched cohort of 30 patients (matched 1:1 for age, HR, albumin on admission, Hb on admission, and dose of first infliximab dose) further confirmed shorter length of stay in the early vs standard group at a median of 6 vs 7 days (p= 0.039).

Conclusion

In patients admitted with ASUC, early infliximab therapy as defined by administration ≤ 72 hours from presentation was associated with shorter hospitalisation, with no difference in rates of colectomy, re-admission or infective complications. An early treatment strategy may reduce the burden of this condition upon health care utilisation.