Evidence map›Paper›PMID 26856754›Full record

SynthesisThe American journal of gastroenterology2016

Systematic Review and Meta-Analysis: Infliximab or Cyclosporine as Rescue Therapy in Patients With Severe Ulcerative Colitis Refractory to Steroids.

Neeraj Narula, John K Marshall, Jean-Frederic Colombel, Grigorios I Leontiadis, John G Williams, Zack Muqtadir, Walter Reinisch

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in The American journal of gastroenterology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03765450 (Pharmacokinetics of Infliximab and Tumor Necrosis Factor Concentrations in Serum, Stool, and Colonic Mucosa in Acute Severe Ulcerative Colitis), which is not on this map. Cited by 90 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 9 pooled it
17.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03765450 active not recruitingnot on this mapstarted 2018, after this paper: background citation

Pharmacokinetics of Infliximab and Tumor Necrosis Factor Concentrations in Serum, Stool, and Colonic Mucosa in Acute Severe Ulcerative Colitis

TypeobservationalSponsorAlimentiv Inc.Ran2018 to 2027Enrolled18ConditionsUlcerative ColitisArmsInfliximab
3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 9 syntheses or guidelines pooled it, 196 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Guideline
  8. Guideline
  9. Pooled it
  10. Trial
  11. Trial
  12. Review
  13. Review
  14. Managing Acute Severe Ulcerative Colitis in 2025 and Beyond.Current gastroenterology reports · 2026
    Review
  15. Review
  16. Article
  17. Review
  18. Editorial: Advances in the treatment of acute severe ulcerative colitis.Frontiers in gastroenterology (Lausanne, Switzerland) · 2026
    Article
  19. Article
  20. Review

30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 4 countries.

Neeraj NarulaDepartment of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
John K MarshallDepartment of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
Jean-Frederic ColombelDepartment of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Grigorios I LeontiadisDepartment of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
John G WilliamsSchool of Medicine, Swansea University, Singleton Park, Swansea, UK.
Zack MuqtadirDepartment of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
Walter ReinischDepartment of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, Ontario, Canada.
McMaster University · CADigestive Health Research Institute · FRIcahn School of Medicine at Mount Sinai · USSwansea University · GB

Funding

Department of Health 06/78/03
6 · The paper itself

Abstract

objectivesAcute severe steroid-refractory ulcerative colitis (UC) carries a poor prognosis and requires optimal management. A systematic review and meta-analysis were conducted to assess cyclosporine and infliximab (IFX) as rescue agents in patients with steroid-refractory UC.

methodsA literature search identified studies that investigated IFX and cyclosporine in steroid-refractory UC patients. The primary outcome was short-term response to treatment. Secondary outcomes included the rates of colectomy at 3 months and 12 months, adverse drug reactions, post-operative complications in those who received rescue therapy but underwent colectomy subsequently, and mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

resultsOverall, 16 studies with 1,473 participants were eligible for inclusion. Among three randomized controlled trials, no significant difference was seen with IFX compared with cyclosporine with regard to treatment response and 3- or 12-month colectomy. Among 13 non-randomized studies, IFX was associated with significantly higher rates of treatment response (OR 2.96 (95% CI 2.12-4.14, χ(2)=6.50, I(2)=0%)) and a lower 12-month colectomy rate (OR 0.42 (95% CI 0.22-0.83, χ(2)=30.94, I(2)=71%)), with no significant difference seen in the 3-month colectomy rate (OR 0.53 (95% CI 0.22-1.28, χ(2)=22.73, I(2)=69%)) compared with cyclosporine. There were no significant differences between IFX and cyclosporine in adverse drug-related events, post-operative complications, or mortality.

conclusionsIn the management of steroid-refractory severe UC, no definitive difference between IFX and cyclosporine is demonstrated by randomized trials, but non-randomized studies suggest that IFX is associated with better treatment response and lower risk of colectomy at 12 months. Prospective studies comparing dose-optimized IFX with cyclosporine are needed.

Indexed as

Colitis, UlcerativeCyclosporineGastrointestinal AgentsHumansImmunosuppressive AgentsInfliximabSteroidsCyclosporineGastrointestinal AgentsImmunosuppressive AgentsInfliximabSteroids

Identifiers

PMID26856754
OpenAlexW2257807249

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.