Intest Res.  2024 Oct;22(4):397-413. 10.5217/ir.2024.00003.

What to do when traditional rescue therapies fail in acute severe ulcerative colitis

• Li Wai Suen CFD
• Choy MC
• De Cruz P

• KMID: 2560291
• DOI: http://doi.org/10.5217/ir.2024.00003

Abstract

Acute severe ulcerative colitis (ASUC) is a medical emergency that affects approximately 25% of patients with ulcerative colitis at some point in time in their lives. Outcomes of ASUC are highly variable. Approximately 30% of patients do not respond to corticosteroids and up to 50% of patients do not respond to rescue therapy (infliximab or cyclosporin) and require emergency colectomy. Data are emerging on infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase inhibition as primary and sequential therapy. In this review, we outline contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies.

Keyword

Acute severe ulcerative colitis; Ulcerative colitis; Infliximab; Cyclosporin; Janus kinase inhibitors

Figure

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  Fig. 1. Factors associated with lack of response to traditional rescue therapy in acute severe ulcerative colitis. CMV, cytomegalovirus; C. difficile, Clostridioides difficile; CRP, C-reactive protein; UCEIS, ulcerative colitis endoscopic index of severity. This figure was created with BioRender.com.

• 

  Fig. 2. Mechanisms of infliximab failure and potential ways to overcome them. ASUC, acute severe ulcerative colitis; MSUC, MSUC, moderate to severe ulcerative colitis; TNF, tumor necrosis factor; JAK, Janus kinase. This figure was created with BioRender.com.

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