BACKGROUND  Acute severe ulcerative colitis (ASUC)  Medical emergency  I.V corticosteroid : mainstay management the past 40 years  One-third of patients fail to respond  Alternative treatment  Cyclosporine  Infliximab (IFX) : monoclonal antibody against TNF-α -> Preferred rescue therapy because of superior outcome

 ASUC  Higher circulating levels of TNF  Increased inflammatory burden  More rapid drug clearance  ASUC patients need  More frequent drug administration  Higher dosing of IFX to maintain therapeutic drug levels  Our aims of this study Accelerated IFX dosing strategy in ASUC - Can reduce colectomy rate both in the initial induction and in the first 2 years after treatment BACKGROUND

 Retrospective review of 50 consecutive patients (from September 2005 to September 2013)  Patient who received rescue cyclosporine were excluded  Before 2011  All patients received a standard dosing(SD) IFX  5 mg/kg at weeks 0,2,6 + maintenance dosing every 8 weeks  In 2011 accelerated dosing(AD) IFX induction strategy was adopted  Patients received 3 induction dose 5 mg/kg + maintenance dosing  Each infusion guided by clinical need  Worsening Sx. or inflammatory maker during much shorter period METHODS

RESULTS

CONCLUSION  An accelerated infliximab induction strategy reduces the need for early colectomy  Similar rates of colectomy were seen in the 2-year period after induction in both SD(standard dose) and AD(accelerated dose) study group  Severe UC patients might require modified dosing strategies including a higher drug dose, a shorter interval between doses, or both