title: Calcineurin inhibitors or anti-TNF-α agents in severe ulcerative colitis: available options and limitations.
abstract: A majority of patients with ulcerative colitis (UC) respond to medical therapy and remain in remission. However, approximately 20 % of UC patients experience severe relapses that require hospitalization. For these cases, intravenous corticosteroids are the established first-line treatment and 70 % of patients respond. Patients who do not respond to corticosteroids within 48 to 72 hours should receive calcineurin inhibitors, anti-TNF-α therapy or total proctocolectomy, which must be selected based on clinical, endoscopic and laboratory parameters and patient preference. The selection of second-line medical therapy after steroid failure, surgery and the benefits of medical salvage therapy following second-line therapy failure represent current challenges in the treatment of acute steroid-refractory colitis. Patients and physicians must realize that immunosuppressive therapies, especially in combination, bear the risk of serious and fatal infections. Therefore, decisions regarding short- and long-term treatment strategies must consider the efficacy and potential toxicity of pharmacological interventions and the quality of life after restorative proctocolectomy with ileal pouch-anal anastomosis.
authors.affiliation: Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine II, Jena University Hospital, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bruns
authors.forename: C
authors.initials: C
authors.lastname: Schmidt
authors.forename: A
authors.initials: A
authors.lastname: Stallmach
mesh_terms: D065095:Calcineurin Inhibitors; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D065095:Calcineurin Inhibitors; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha