SynthesisFrontiers in gastroenterology (Lausanne, Switzerland)2026
Comparative outcomes of advanced medical rescue therapies in steroid-refractory acute severe ulcerative colitis: a systematic review and network meta-analysis.
Synthesis in Frontiers in gastroenterology (Lausanne, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Steroid-refractory acute severe ulcerative colitis is a medical emergency associated with a substantial risk of colectomy. Although infliximab and calcineurin inhibitors are established rescue treatments, comparative evidence regarding alternative drugs, infliximab dosing strategies, and newer small-molecule therapies remains limited. We conducted a systematic review and network meta-analysis to compare the efficacy and safety of available medical rescue strategies. Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception through June 30, 2026. Randomized controlled trials and comparative observational studies enrolling adults hospitalized with steroid-refractory acute severe ulcerative colitis were eligible. Separate frequentist random-effects network meta-analyses were conducted for colectomy at approximately 12-14 weeks, colectomy during hospitalization or within 30 days, colectomy at approximately 12 months, and serious adverse events. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Risk of bias was assessed using RoB 2 and ROBINS-I. Results: Of 5, 498 records identified, 18 studies involving 1, 529 participants met the eligibility criteria, including three randomized trials and 15 observational studies. At approximately 12-14 weeks, ciclosporin was associated with higher odds of colectomy than standard-dose infliximab (OR 2.19, 95% CI 1.17-4.12). Neither high-dose infliximab (OR 2.92, 95% CI 0.42-20.26) nor accelerated infliximab (OR 4.57, 95% CI 0.88-23.75) differed significantly from standard-dose infliximab. Ciclosporin was also associated with higher odds of early colectomy (OR 3.05, 95% CI 1.38-6.77) and 12-month colectomy (OR 3.65, 95% CI 1.98-6.72) than standard-dose infliximab. Tacrolimus and accelerated infliximab did not differ significantly from standard-dose infliximab at either time point. Serious adverse events were similar between ciclosporin and infliximab (OR 0.94, 95% CI 0.54-1.63). The networks contained no closed loops, and most observational studies were judged to have a serious risk of bias. Conclusions: In the combined randomized and observational evidence, standard-dose infliximab was associated with lower colectomy odds than ciclosporin, without a detectable difference in serious adverse events. No consistent advantage was demonstrated for accelerated or high-dose infliximab. Because the apparent efficacy advantage of infliximab was driven predominantly by observational studies, whereas randomized trials showed comparable outcomes, the findings should be interpreted cautiously. Further adequately powered randomized comparisons incorporating contemporary biologic-exposed populations and newer small-molecule therapies are required. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420261412884.
Indexed as
Identifiers
What OpenQuestion holds
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.