Early infliximab rescue therapy is associated with reduced length of stay in patients with acute severe ulcerative colitis

Patients with acute severe ulcerative colitis (ASUC) inadequately responding to intravenous steroids commonly require rescue therapy, most commonly with infliximab or cyclosporine, traditionally administered on day 3 of admission based on Modified Oxford Criteria. This study aimed to evaluate the impact of early (≤ 72 hours) versus standard (> 72 hours) infliximab administration on different clinical outcomes. A retrospective medical records review of patients admitted with ASUC who were administered infliximab rescue therapy due to inadequate steroid response was performed. Patients were divided into 2 groups: early infliximab therapy (≤ 72 hours of admission) and standard infliximab therapy (> 72 hours of admission). Outcomes assessed included length of stay, 12-month readmission and colectomy rates, and infective complications. 84 patients (31 [37%] female, median age 34 [range 29-48.5] years) were included. 31 (37%) received early (median 52 [IQR 45–56] hours) and 53 (63%) had standard (median 105 [IQR 94–149] hours) infliximab therapy, with no significant demographic differences. Median length of stay was shorter in the early vs. standard group at 6 vs. 7 days (p = 0.048). No significant difference was seen in requirement for colectomy at index admission or at 12-months follow up (p > 0.99). Similarly, there was no significant difference in readmission rates at 6- (33.3% vs. 30%, p = 0.76) or 12-months (40% vs. 33.3% p = 0.64). There was no difference in rate of infective complications in the first 30 days. Early infliximab therapy was associated with shorter hospitalisation, with no difference in rates of colectomy, re-admission or infective complications.