Effects of prednisolone tapering on effectiveness of infliximab in patients with ulcerative colitis: data from a retrospective cohort

BMJ Open Gastroenterol. 2024 May 7;11(1):e001343. doi: 10.1136/bmjgast-2024-001343.


Background and objective: The influence of concomitant prednisolone on clinical outcomes and safety in infliximab-treated ulcerative colitis (UC) patients is unknown.

Design, setting, participants and outcome measures: A retrospective cohort study was performed, including 147 UC patients treated with infliximab at a tertiary inflammatory bowel disease (IBD) centre. Primary outcome was corticosteroid-free clinical remission (CFCR) at week 14 and week 52. Patients were grouped according to prednisolone tapering regimens: standard (≤5 mg/week), fast (>5 mg/week), direct discontinuation or no prednisolone. Patients intolerant to corticosteroids and patients stopping corticosteroids in preparation for surgery including colectomy during their initial admission were excluded.

Results: There was no overall association between prednisolone exposure or no exposure and CFCR at weeks 14 or 52 of infliximab. The proportion of patients with C reactive protein ≤5 mg/L was higher in the standard tapering at week 14 as compared with faster regimens or no prednisolone. In subgroup analyses, the standard tapering was associated with a higher rate of CFCR at week 14 compared with the fast-tapering regimen in patients receiving ≥40 mg prednisolone at initiation of infliximab (64.3% vs 26.3%, p=0.04) and among patients admitted with acute severe UC (66.6% vs 23.5%, p<0.05). Similar data were seen at week 52. Prednisolone did not affect infliximab trough levels but increased infection rates (10/77 vs 2/70, p=0.03), in particular C. difficile infection.

Conclusion: In UC patients with limited disease burden, prednisolone did not affect effectiveness of infliximab. However, patients with increased disease burden seem to benefit from corticosteroid combination therapy.


Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism
  • Colitis, Ulcerative* / drug therapy
  • Drug Tapering / methods
  • Drug Therapy, Combination
  • Female
  • Gastrointestinal Agents* / administration & dosage
  • Gastrointestinal Agents* / therapeutic use
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use
  • Humans
  • Infliximab* / administration & dosage
  • Infliximab* / therapeutic use
  • Male
  • Middle Aged
  • Prednisolone* / administration & dosage
  • Prednisolone* / therapeutic use
  • Remission Induction* / methods
  • Retrospective Studies
  • Treatment Outcome


  • Infliximab
  • Prednisolone
  • Gastrointestinal Agents
  • Anti-Inflammatory Agents
  • C-Reactive Protein
  • Glucocorticoids