This multicenter retrospective study (GETECCU, 2014–2024) evaluated predictors of IV corticosteroid failure and outcomes of biologic rescue therapy in 211 hospitalized adults with grade 3–4 immune checkpoint inhibitor–induced colitis (IMC).
Corticosteroids worked in only 50.2% of patients. Independent predictors of steroid failure were prior oral corticosteroid use (OR 4.4), higher UCEIS score (OR 1.31), and higher modified Mayo score (OR 1.45). Among the 113 rescue therapy courses given (infliximab, vedolizumab, or ustekinumab), effectiveness rates were 65–72%; greater clinical severity was the only factor tied to worse rescue response.
- Retrospective design limits causal inference and may introduce selection bias. - Rescue therapy choice (infliximab vs. vedolizumab vs. ustekinumab) was not randomized, so head-to-head comparisons between biologics are not possible. - Full-text data are behind a paywall; detailed subgroup results and safety data were not available for review.
In severe ICI-induced colitis, patients who had prior outpatient steroids, high symptom scores, or endoscopic ulcerations are unlikely to respond to IV corticosteroids—consider early escalation to biologic therapy for these patients. Symptom severity at presentation should also guide expectations for biologic rescue response.
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