Personalized Infliximab Dosing in ASUC: JCC | March 2026

Introduction

Acute severe ulcerative colitis (ASUC) is a life-threatening condition requiring urgent treatment. In patients who fail steroids, Infliximab is widely used as rescue therapy. However, response is highly variable, and a significant proportion of patients still require colectomy despite treatment. One major limitation is the lack of individualized dosing strategies, as drug pharmacokinetics in ASUC are highly unpredictable due to inflammation, protein loss, and altered clearance.

Problem Statement

Standard infliximab dosing does not account for patient-specific pharmacokinetics, leading to suboptimal exposure and increased risk of colectomy in ASUC.

Summary

This multicenter study developed a pharmacokinetic-based model to personalize infliximab therapy in ASUC. The key finding was that infliximab exposure between weeks 2–4, adjusted for drug clearance (AUCw2–4/CL), strongly predicted colectomy risk within 90 days.

Patients with low exposure (log AUC/CL < 5.79) were identified as high risk for colectomy, with good predictive accuracy (≈85%). The model incorporated simple clinical parameters such as body weight, CRP, and drug levels to estimate individualized drug exposure.

This approach allows early identification of patients who may benefit from intensified dosing strategies, moving beyond fixed regimens toward precision therapy.

Clinically, this represents a paradigm shift—from “one-size-fits-all” rescue therapy to personalized infliximab optimization—aimed at maximizing colectomy-free survival in ASUC.