Background: Hospitalized children with severe Ulcerative Colitis who are steroid unresponsive often receive Infliximab (IFX). Standard IFX induction dose is 5mg/kg weeks 0, 2 & 6. The rationale for intensified infliximab induction (III) in severe UC is: higher inflammatory burden, increase in IFX clearance & stool losses. There are no pediatric data on the outcomes of III. Aim: Report clinical outcomes of hospitalized children with severe colitis who received III. Methods: Retrospective review of patients <18 years hospitalized October 2011-June 2017 with severe UC who received their 1st induction IFX. Patients were divided into 2 groups: III (IFX ≥15mg/kg in ≤14 days) vs controls (<15mg/kg in <14 days or >15mg/kg in >14 days). Data included patients’ demographics, PUCAI, CRP, albumin, prior therapy & clinical outcomes. We used two-sample t-test and Wilcoxon rank-sum for parametric and non-parametric data respectively to assess association between clinical variables & colectomy outcome. Results: We identified 40 patients. Mean age at IFX induction 13.5 (± 3.7) years. All patients had prior steroid exposure. 2/40 patients had prior biologic exposure (Adalimumab). 16/40 patients received III. Data suggested higher CRP in the III group, but not reaching statistical significance. The two groups were similar in age, albumin and PUCAI scores at the time of first infliximab. 43% children in III group underwent colectomy vs 37% controls. Surgery occurred during the same hospitalization as IFX initiation for 57% of patients with III vs none in controls. Median time from 1st IFX to colectomy in III group was 30 days (range 13-107) vs 150 days (26-910), (P=0.0502). Conclusion: Our study suggests comparable clinical features between patients who received intensified IFX induction and controls. Although the data suggested shorter time to colectomy with intensified IFX induction without statistical significance, colectomy rate was relatively similar to non-intensified infusions.
