In patients hospitalized with ASUC, is initial treatment with infliximab or cyclosporine A preferred

What is known

- Meta-analysis found comparable long-term outcomes for cyclosporine and infliximab in steroid-refractory acute severe UC. ¹ - Following initial response to cyclosporine, about 50% of patients avoid colectomy at three years, with lower rates on longer follow-up. ^2,3 - A small placebo-controlled trial showed infliximab reduced colectomy at three months versus placebo in steroid-refractory disease. ^2,3 - Both agents carry increased risk of serious opportunistic infections; cyclosporine contraindications include renal insufficiency, infection, hypocholesterolemia, hypertension. ^3,4

What is unknown / caveats

- Some data suggest cyclosporine-treated patients with more severe endoscopic lesions are at increased colectomy risk - Much comparative data is retrospective and single-center - Excerpts note initial reports of increased postoperative septic complications with infliximab but do not resolve this - The excerpts do not establish one agent as superior for initial rescue therapy.

## References

1. 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.

2. Van Assche G, Vermeire S, Rutgeerts P. Treatment of severe steroid refractory ulcerative colitis. World J Gastroenterol. 2008;14:5508-11. PMID: 18810767.

3. Van Assche G, Vermeire S, Rutgeerts P. Management of acute severe ulcerative colitis. Gut. 2011;60:130-3. PMID: 21030524.

4. Pola S, Patel D, Ramamoorthy S, McLemore E, Fahmy M, Rivera-Nieves J, Chang JT, Evans E, Docherty M, Talamini M, Sandborn WJ. Strategies for the care of adults hospitalized for active ulcerative colitis. Clin Gastroenterol Hepatol. 2012;10:1315-1325.e4. PMID: 22835577.

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_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._