In elderly patients (≥70 years) with steroid‑refractory ASUC and significant renal impairment, is cyclosporine or infliximab safer as rescue therapy
Out of scope for this tool. The focus of this literature tool is the surgical management of IBD. For medical management and drug dosing, please see ChatIBD.com.
infliximab is preferred when cyclosporine is contraindicated, including in renal impairment, and when the risk of nephrotoxicity is high, such as with concomitant nephrotoxic drug use 1. cyclosporine carries a narrow therapeutic window and requires mandatory monitoring of serum levels and adverse events, particularly for toxicity 1,2, so it is generally avoided when renal function is compromised or when therapeutic drug monitoring is unavailable 1. 1–3
What is known: - Infliximab should be considered preferentially where cyclosporine is contraindicated, such as renal impairment, and where nephrotoxicity risk is high. 1 - Cyclosporine has a narrow therapeutic window and mandates monitoring for toxicity and serum levels; it is largely underused because of intense monitoring needs. 1,2 - Cyclosporine and infliximab are reported to be similarly effective for steroid-refractory acute severe UC, with comparable long-term outcomes. 2,3 - Rescue therapy choice should be individualized to patient factors and comorbidities, intended maintenance, and local familiarity. 1
What is unknown / caveats: - No excerpt reports outcomes specifically in patients aged ≥70 years - The renal-impairment guidance is from a narrative review, not a comparative trial in this subgroup - The excerpts do not quantify safety outcomes for either agent specifically in elderly patients with renal impairment.
## References
1. Li Wai Suen CFD, Choy MC, De Cruz P. What to do when traditional rescue therapies fail in acute severe ulcerative colitis. Intest Res. 2024;22:397-413. PMID: 38749658.
2. Kumar NS, Khosla R, Makharia GK. Cyclosporine in steroid refractory acute severe colitis. Trop Gastroenterol. 2014;35 Suppl 1:S21-8. PMID: 25735123.
3. Szemes K, Soós A, Hegyi P, Farkas N, Erős A, Erőss B, Mezősi E, Szakács Z, Márta K, Sarlós P. Comparable Long-Term Outcomes of Cyclosporine and Infliximab in Patients With Steroid-Refractory Acute Severe Ulcerative Colitis: A Meta-Analysis. Front Med (Lausanne). 2019;6:338. PMID: 32039218.
For educational use only, not a substitute for clinical judgement or medical advice. Consult qualified clinicians for diagnosis and treatment decisions. This tool may contain errors; use the flag button below to report inaccurate or harmful content.
---
_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._
Reviewer notes