P0981 Comparative efficacy of standard vs enhanced dose treatment with infliximab in the management of acute severe ulcerative colitis: a single centre retrospective cohort study
Bibliographic record
Abstract
Abstract Background Acute severe ulcerative colitis (ASUC) often requires rescue therapy with infliximab, typically administered at an initial dose of 5mg/kg or 10mg/kg. There is some uncertainty regarding the optimal dose of infliximab for rescue therapy and current guidance leaves this to the discretion of the treating clinician. A previous multicentre randomised controlled trial (PREDICT-UC) did not find a significant difference in clinical response or colectomy rates between 5mg/kg and 10mg/kg of infliximab in steroid-refractory ASUC 1. This study aimed to compare the clinical outcomes of patients receiving either 5mg/kg or 10mg/kg infliximab in the management of ASUC. Methods This retrospective cohort study examined patients with ASUC who were treated with rescue infliximab between 2019 and 2022. Patients were categorised into two groups based on the dose received; 5mg/kg and 10mg/kg. Demographic and clinical variables, including age, sex, disease extent (Montreal classification), and prior treatments (no prior treatment, 5-ASA, biologics), were recorded. The outcomes measured included remission (defined as sustained remission at 1 year), the need for surgery, the requirement for additional doses of infliximab, or change in biological agent. Outcomes at 1 month, 6 months, and 1 year were also recorded. Chi-square tests were used to analyse differences between the two treatment groups. Results Of the 50 UC patients, 60% received 5 mg/kg, and 40% received 10 mg/kg. No significant differences were found between the 5 mg/kg and 10 mg/kg infliximab treatment groups for outcomes including surgery (p = 1.00), remission (p = 0.22), and biologic switch (p = 0.22). Additionally, no significant differences were observed when categorising patients by pre-existing treatment (p = 0.06) or disease severity subgroups (E1, E2, E3). When assessing the effect of severe disease markers on treatment outcomes, no significant difference in colectomy rates was found between the two groups for CRP > 50 mg/L (p = 0.34) and albumin < 25 g/L (p = 0.13). Conclusion This study showed no significant difference in the clinical outcomes between patients receiving 5mg/kg and 10mg/kg infliximab for the management of ASUC. These findings suggest that escalating the dose to 10mg/kg does not provide a clear clinical advantage in reducing the need for surgery or achieving sustained remission. Larger, multicentre studies with more diverse patient populations are needed to further investigate the potential benefits of higher infliximab dosing in this clinical context. References 1.Intensified versus standard dose infliximab induction therapy for steroid-refractory acute severe ulcerative colitis (PREDICT-UC): an open-label, multicentre, randomised controlled trial. Choy, Matthew C et al. The Lancet Gastroenterology & Hepatology, Volume 9, Issue 11, 981 - 996
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".