NEW research suggests that acting sooner with infliximab in acute severe ulcerative colitis (ASUC) could help patients leave hospital earlier, without increasing risks.
Infliximab is commonly used as rescue therapy when patients fail to respond to intravenous steroids, typically introduced around day 3 of admission. However, this study explored whether giving it earlier could improve outcomes.
Shorter Hospital Stays with Earlier Treatment
In this retrospective analysis of 84 patients with ASUC, those who received infliximab within 72 hours of admission had a shorter median hospital stay compared to those treated later.
Patients in the early treatment group were discharged after a median of 6 days, compared to 7 days in the standard timing group. While the difference may seem small, even modest reductions in length of stay can have significant implications for both patients and healthcare systems.
No Trade-Off in Safety or Outcomes
Importantly, earlier treatment did not come at the expense of safety. Rates of colectomy during admission and at 12 months were similar between groups, as were readmission rates at both 6 and 12 months.
There was also no increase in short-term infectious complications, suggesting that accelerating infliximab use does not expose patients to additional risk.
Rethinking the Timing of Rescue Therapy
Current practice often follows the Modified Oxford Criteria, which recommend waiting until day 3 before escalating treatment. However, these findings suggest that earlier intervention could be beneficial, at least in terms of reducing hospital burden.
Clinical Implications
For clinicians, the message is pragmatic: if a patient is clearly not responding to steroids, delaying escalation may not offer additional benefit, and could prolong hospitalisation unnecessarily.
What Comes Next
While the study is limited by its retrospective design and relatively small sample size, it raises an important question about whether current treatment timelines are too conservative.
Prospective trials will be needed to confirm whether earlier infliximab should become standard practice. But for now, the data suggest that in acute severe ulcerative colitis, waiting may not always be the best strategy.
References
Mohamedrashed M et al. Early infliximab rescue therapy is associated with reduced length of stay in patients with acute severe ulcerative colitis. BMC Gastroenterol. 2026;DOI: 10.1186/s12876-026-04847-w.
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