Infliximab Clearance May Identify ASUC Patients Needing Intensified Induction: FG | September 2027

Introduction:

Infliximab is an established rescue therapy for steroid-refractory acute severe ulcerative colitis (ASUC), but severe inflammation can accelerate drug clearance and reduce exposure. This study examined whether baseline infliximab clearance (CL) could identify patients who may require intensified induction.

Why was this study needed?

Standard infliximab induction may provide inadequate drug exposure in ASUC.

Hypoalbuminemia and severe inflammation can increase infliximab clearance.

Intensified dosing is widely used, but which patients need it remains uncertain.

Pharmacokinetic-guided dosing could potentially personalize rescue therapy.

Key Findings:

The study included 74 patients with ASUC and 90 outpatients.

Baseline infliximab clearance was 30% higher in ASUC (0.456 vs 0.350 L/day).

35% of ASUC patients received intensified induction.

These patients had 18% higher baseline clearance than those receiving standard induction.

A clearance threshold of ≥0.42 L/day identified patients more likely to receive intensified therapy.

Clearance performed better than albumin alone for identifying intensification.

Among patients receiving standard induction, high clearance showed a numerical signal toward higher 1-year colectomy (19% vs 5%), although not statistically significant.

Prospective studies are needed to determine whether clearance-guided dosing actually reduces colectomy.

Bottom Line:

High baseline infliximab clearance may identify ASUC patients at risk of inadequate exposure with standard induction. Pharmacokinetic-guided intensified dosing is promising, but requires prospective validation before routine use.