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Comparison of outcomes of cyclosporine A and infliximab for steroid‐refractory acute severe ulcerative colitis

We read with interest the article by Eun Mi Song et al. comparing the outcomes of CsA and IFX as rescue therapy among patients with SR-ASUC in a large, well-defined cohort of Korean UC patients. The author found that the rates of treatment failure and colectomy at 3 months were not significantly different between the CsA and the IFX treatment groups among Korean patients with SR-ASUC. Because their findings are different to previous studies, we have performed a systematic review and meta-analysis of available studies evaluating the short-term and long-term efficacy of IFX of CsA in SR-ASUC. Fourteen studies which fulfilled inclusion criteria were included in the meta-analysis. There are 11 non-randomized studies and three RCTs. The diagnostic criteria of ASUC used in these studies were the Truelove and Witts criteria, Montreal severity score, the Mayo, and the Lichtiger scores. Eleven studies (two RCTs and nine non-randomized studies) reported therapeutic response rate and included 470 patients who received IFX and 536 patients who received CsA. The pooled OR for therapeutic response rate among two RCTs was 1.31 (95% CI 0.78–2.21, P = 0.922, I = 0%) (Fig. 1). The pooled response rate in RCTs is 46.4% for those receiving IFX and 39.8% for those receiving CsA. Among non-randomized studies, significantly higher therapeutic response rate was seen with IFX treatment, with a pooled OR of 2.46 (95% CI 1.87–3.25, P = 0.873, I = 0%) (Fig. 1). The pooled response rate in non-randomized studies is 73.5% in the group receiving IFX and 51.2% in the CsA group. Ten studies (two RCTs and eight non-randomized studies) reported 3-month colectomy rates and included 518 patients who received IFX and 768 patients who received CsA. The pooled OR for 3-month colectomy rates among two RCTs was 0.95 (95% CI 0.60–1.50, P = 0.476, I = 0%). Among non-randomized studies, no statistically significant difference could be detected between the two groups in 3-month colectomy rate, with a pooled OR of 0.58 (95% CI 0.29–1.17, P = 0.01, I = 62.2%).