title: Systematic Review and Meta-Analysis: Infliximab or Cyclosporine as Rescue Therapy in Patients With Severe Ulcerative Colitis Refractory to Steroids.
abstract: 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 cyclosporine and infliximab (IFX) as rescue agents in patients with steroid-refractory UC.
  
  
  
  A literature search identified studies that investigated IFX and cyclosporine in steroid-refractory UC 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, post-operative complications in those who received rescue therapy but underwent colectomy subsequently, and mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported.
  
  
  
  Overall, 16 studies with 1,473 participants were eligible for inclusion. Among three randomized controlled trials, no significant difference was seen with IFX compared with cyclosporine with regard to treatment response and 3- or 12-month colectomy. Among 13 non-randomized studies, IFX was associated with significantly higher rates of treatment response (OR 2.96 (95% CI 2.12-4.14, χ(2)=6.50, I(2)=0%)) and a lower 12-month colectomy rate (OR 0.42 (95% CI 0.22-0.83, χ(2)=30.94, I(2)=71%)), with no significant difference seen in the 3-month colectomy rate (OR 0.53 (95% CI 0.22-1.28, χ(2)=22.73, I(2)=69%)) compared with cyclosporine. There were no significant differences between IFX and cyclosporine in adverse drug-related events, post-operative complications, or mortality.
  
  
  
  In the management of steroid-refractory severe UC, no definitive difference between IFX and cyclosporine is demonstrated by randomized trials, but non-randomized studies suggest that IFX is associated with better treatment response and lower risk of colectomy at 12 months. Prospective studies comparing dose-optimized IFX with cyclosporine are needed.
authors: Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
authors: Neeraj
authors: N
authors: Narula
authors: Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
authors: John K
authors: JK
authors: Marshall
authors: Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors: Jean-Frederic
authors: JF
authors: Colombel
authors: Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
authors: Grigorios I
authors: GI
authors: Leontiadis
authors: School of Medicine, Swansea University, Singleton Park, Swansea, UK.
authors: John G
authors: JG
authors: Williams
authors: Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
authors: Zack
authors: Z
authors: Muqtadir
authors: Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
authors: Walter
authors: W
authors: Reinisch
mesh_terms: D003093:Colitis, Ulcerative / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D000069285:Infliximab