Long-term comparative effectiveness of first-line infliximab vs corticosteroids in ulcerative colitis: Remission and colectomy risk

doi:10.3748/wjg.121333

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Oct 14, 2026; 32(38): 121333
Published online Oct 14, 2026. doi: 10.3748/wjg.121333

Table 1 Demographic and baseline clinical and laboratory characteristics of both groups, median (interquartile range)/n (%)

Characteristics	Group 1 (IFX), n = 68	Group 2 (IVCS), n = 71	P value
Age (years)	49 (45, 55)	55 (49, 62)	0.101
Gender			0.487
Male	41 (60.3)	47 (66.2)
Female	27 (39.7)	24 (33.8)
Body weight (kg)	68.5 (65, 82)	70 (66, 90)	0.422
Smoking habits			0.950
Heavy smoker	10 (14.7)	9 (12.7)
Moderate smoker	9 (13.2)	9 (12.7)
Ex smoker	13 (19.1)	12 (16.9)
Nonsmoker	36 (52.9)	41 (57.7)
Family history of IBD			0.832
Crohn’s disease	10 (14.7)	8 (11.3)
UC	12 (17.6)	16 (22.5)
UC extent (Montreal)			0.655
E1 (proctitis)	21 (30.9)	17 (23.9)
E2 (left-sided colitis)	29 (42.6)	33 (46.5)
E3 (extensive colitis)	18 (26.5)	21 (29.6)
Mayo score	10 (9, 12)	10.5 (9, 12)	0.542
Geboes score	4 (3.8, 5)	4 (4, 4)	0.920
Interval from diagnosis to treatment initiation (weeks)	1.4 (1.0, 2.2)	1.2 (0.7, 2.0)	0.117
Disease severity			1.000
Moderate UC	36 (52.9)	38 (53.5)
Severe UC	32 (47.1)	33 (46.5)
Extraintestinal manifestations			0.850
Aphthous ulcers	3 (4.4)	2 (2.8)
Erythema nodosum	2 (2.9)	1 (1.4)
Peripheral arthritis	2 (2.9)	3 (4.2)
Laboratory findings
CRP (mg/dL)	28 (23.5, 35)	30 (25, 35)	0.058
Albumen (g/dL)	3 (2.5, 3.1)	3 (3, 3.3)	0.098
Fecal calprotectin (μg/g)	903 (800, 1100)	895 (700, 989)	0.137
Hb (g/dL)	11 (10, 12)	11 (10, 12)	0.787
Leucocytes (10⁹/L)	10 (7, 11)	8 (7, 11)	0.829
Platelets (cm²)	250 (160, 450)	245 (170, 433)	0.847

Values present as n (%) were analyzed by χ² or Fisher’s exact tests. Values present as median (interquartile range) were analyzed by Mann-Whitney test. IFX: Infliximab; IVCS: Intravenous corticosteroids; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CRP: C-reactive protein; Hb: Hemoglobin.

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Table 2 Long-term outcomes at different follow-up periods among both groups, n (%)

Outcomes	Weeks 48			Weeks 96			Weeks 144
Outcomes	Group 1 (IFX), n = 68	Group 2 (IVCS), n = 71	P value	Group 1 (IFX), n = 68	Group 2 (IVCS), n = 71	P value	Group 1 (IFX), n = 68	Group 2 (IVCS), n = 71	P value
Clinical remission	39 (57.4)	21 (29.6)	0.001^b	30 (44.1)	19 (26.8)	0.035^a	25 (36.8)	11 (15.5)	0.006^b
Endoscopic remission	28 (41.2)	17 (23.9)	0.045^a	26 (38.2)	14 (19.7)	0.024^a	17 (25.0)	7 (9.9)	0.024^a
Histologic remission	22 (32.4)	15 (21.1)	0.179	21 (30.9)	10 (14.1)	0.024^a	14 (20.6)	5 (7.0)	0.026^a
Colectomy¹	4 (5.9)	4 (5.6)	1.000	4 (5.9)	8 (11.3)	0.367	4 (5.9)	13 (18.3)	0.037^a
Mortality²	2 (2.9)	2 (2.8)	1.000	2 (2.9)	4 (5.6)	0.681	2 (2.9)	6 (8.5)	0.275

^aP < 0.05.

^bP < 0.01.

¹In group 1 (infliximab) (n = 4), indications include refractoriness to medical therapy (n = 2), colonic perforation (n = 1), and acute fulminant ulcerative colitis with refractory hemorrhage (n = 1); whereas in group 2 (Intravenous corticosteroids) (n = 13), indications include refractoriness to medical therapy (n = 9), high grade dysplasia (n = 2), colorectal cancer (n = 1), and toxic megacolon (n = 1).

²In group 1 (infliximab) (n = 2), causes include colonic perforation with septicemia (n = 1) and acute fulminant ulcerative colitis with refractory hemorrhage and post operative septicemia (n = 1); whereas in group 2 (intravenous corticosteroids) (n = 6), causes include colonic perforation with septicemia (n = 4), colorectal cancer (n = 1), and toxic megacolon (n = 1).

Values were analyzed by Fisher’s exact test. IVCS: Intravenous corticosteroids; IFX: Infliximab.

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Table 3 Multivariable Cox regression analysis of independent predictors of colectomy in patients with moderate-to-severe ulcerative colitis

Predictors	B	P value	Exp(B)	95%CI for Exp(B)
CRP	0.05	0.040^a	1.05	1.01-1.14
Albumin	-0.25	0.035^a	0.78	0.13-0.93
Fecal calprotectin	0.37	0.003^b	1.45	1.11-4.01
Severity (severe UC)	0.71	0.042^a	2.04	1.24-4.46
Extensive colitis	0.17	0.134	1.18	0.17-3.16
CMV infection	1.77	< 0.001^b	5.86	1.09-12.53
C. difficile infection	0.52	0.018^a	1.68	1.22-5.48
Treatment group (IFX vs IVCS)	-0.64	0.043^a	0.53	0.20-0.88

^aP < 0.05.

^bP < 0.01.

B: Regression coefficients, Exp(B): Hazard ratio. Hazard ratios < 1 indicate a reduced risk of colectomy. C. difficile: Clostridioides difficile; CRP: C-reactive protein; UC: Ulcerative colitis; CMV: Cytomegalovirus; IVCS: Intravenous corticosteroids; IFX: Infliximab.

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Citation: Elsaadany HM, Abd El-Hamid B, Elewesy EA, Mansour MI, Abdelghany WM, Shoukeer MAH, Khalaf M, Eid SM, Almaghraby MT. Long-term comparative effectiveness of first-line infliximab vs corticosteroids in ulcerative colitis: Remission and colectomy risk. World J Gastroenterol 2026; 32(38): 121333
URL: https://www.wjgnet.com/1007-9327/full/v32/i38/121333.htm
DOI: https://dx.doi.org/10.3748/wjg.121333

Elsaadany HM, Abd El-Hamid B, Elewesy EA, Mansour MI, Abdelghany WM, Shoukeer MAH, Khalaf M, Eid SM, Almaghraby MT. Long-term comparative effectiveness of first-line infliximab vs corticosteroids in ulcerative colitis: Remission and colectomy risk. World J Gastroenterol 2026; 32(38): 121333 [DOI: 10.3748/wjg.121333]

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