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World J Gastroenterol. Oct 14, 2026; 32(38): 121333
Published online Oct 14, 2026. doi: 10.3748/wjg.121333
Published online Oct 14, 2026. doi: 10.3748/wjg.121333
Long-term comparative effectiveness of first-line infliximab vs corticosteroids in ulcerative colitis: Remission and colectomy risk
Hossam M Elsaadany, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, New Damietta 34517, Damietta, Egypt
Basem Abd El-Hamid, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut 71514, Egypt
Emad A Elewesy, Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo 11511, Egypt
Mohamed I Mansour, Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig 44511, Sharkia, Egypt
Wafaa M Abdelghany, Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo 11511, Egypt
Maged A H Shoukeer, Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo 11511, Egypt
Maged A H Shoukeer, Department of Radiology, Armed Forces Hospital, Southern Region, Khamis Mushait 50485, Saudi Arabia
Mohamed Khalaf, Department of Radiology, National Cancer Institute, Cairo University, Cairo 11511, Egypt
Sameh M Eid, Department of Head Radiology, Ibn Sina College Hospital, Jeddah 21955, Saudi Arabia
Mohammed T Almaghraby, Department of Internal Medicine, Faculty of Medicine, Benha University, Benha 54213, Egypt
Author contributions: Elsaadany HM, Abd El-Hamid B, Elewesy EA and Mansour MI performed the endoscopic procedures; Elsaadany HM, Abd El-Hamid B, Mansour MI, Abdelghany WM and Almaghraby MT collected the data; Elewesy EA and Mansour MI performed colectomy procedures; Elsaadany HM, Mansour MI, Abdelghany WM and Almaghraby MT interpreted the data; Elsaadany HM and Abdelghany WM performed the statistical analysis; Elsaadany HM, Shoukeer MAH, Khalaf M, Eid SM and Almaghraby MT drafted and revised the manuscript; Elsaadany HM and Almaghraby MT designed the research study and methodology; all authors critically reviewed, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.
AI contribution statement: AI tools (specifically ChatGPT, version GPT-5.3) were used solely for language editing, grammar correction, and minor structural refinement of the manuscript. No AI tools were used in the study design, data collection, data analysis, interpretation of results, or development of conclusions. All AI-assisted outputs were carefully reviewed, validated, and substantially revised by the authors. The authors take full responsibility for the accuracy, originality, and integrity of the manuscript in accordance with the guidelines of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).
Institutional review board statement: This study was approved by the Institutional Review Boards of Ibn Sina National College Hospitals and the Al-Jedaani Group of Hospitals (No. IRRB-EC/ER-02-01082019). All study procedures were conducted in accordance with the Declaration of Helsinki and relevant institutional and national ethical guidelines for research involving human participants. Participant safety, confidentiality, and privacy were strictly maintained throughout the study.
Clinical trial registration statement: This study was designed as a prospective observational multicenter cohort study and did not involve randomized treatment allocation or interventional trial procedures. Therefore, registration in a clinical trial registry was not required.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets used and analyzed in this study are available from the corresponding author on reasonable request. Confidentiality and security of data and materials were ensured through all stages of the study.
Corresponding author: Hossam M Elsaadany, MD, Consultant, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Al-Bahr Street, Third District, New Damietta 34517, Damietta, Egypt. dr.saadany2019@gmail.com
Received: March 23, 2026
Revised: May 9, 2026
Accepted: June 17, 2026
Published online: October 14, 2026
Processing time: 168 Days and 8.6 Hours
Revised: May 9, 2026
Accepted: June 17, 2026
Published online: October 14, 2026
Processing time: 168 Days and 8.6 Hours
Core Tip
Core Tip: This prospective multicenter study compared first-line infliximab with intravenous corticosteroids in patients with moderate-to-severe ulcerative colitis. Early use of infliximab was associated with higher rates of sustained clinical, endoscopic, and histologic remission, along with a significantly reduced risk of colectomy over long-term follow-up. In contrast, intravenous corticosteroids was linked to lower remission durability and higher rates of severe adverse events. These findings support a shift toward early biologic therapy in selected high-risk patients to improve long-term outcomes and reduce steroid-related complications.