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What to do when traditional rescue therapies fail in acute severe ulcerative colitis
Christopher F. D. Li Wai Suen, Matthew C. Choy, Peter De Cruz
Intest Res 2024;22(4):397-413.   Published online May 16, 2024
DOI: https://doi.org/10.5217/ir.2024.00003
AbstractAbstract PDFPubReaderePub
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.

Citations

Citations to this article as recorded by  
  • Early Infliximab Levels and Clearance Predict Outcomes After Infliximab Rescue in Acute Severe Ulcerative Colitis: Results From PREDICT-UC
    Christopher F.D. Li Wai Suen, Matthew C. Choy, Danny Con, Kaylene Cheng, Julie Nigro, Kerry Breheney, Kristy Boyd, Raquel Pena, Kathryn Burrell, Ourania Rosella, David Proud, Richard Brouwer, Alexandra Gorelik, Danny Liew, William R. Connell, Emily K. Wri
    Gastroenterology.2026; 170(1): 118.     CrossRef
  • Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
    Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha
    Intestinal Research.2026; 24(1): 27.     CrossRef
  • Monocyte Distribution Width Differentiates Bacterial Enterocolitis from Acute Severe Ulcerative Colitis in the Emergency Department
    Christopher F. D. Li Wai Suen, Shipraa Kaul, Ethan X. Z. Tan, Danny Con, Michelle Taylor, Joanne Wiid, Chris Hogan, Matthew C. Choy, Kumar Visvanathan, Peter De Cruz
    Digestive Diseases and Sciences.2026;[Epub]     CrossRef
  • Intensified infliximab induction therapy for steroid-refractory acute severe ulcerative colitis – Authors’ reply
    Christopher F D Li Wai Suen, Matthew C Choy, Danny Con, Peter De Cruz
    The Lancet Gastroenterology & Hepatology.2025; 10(1): 19.     CrossRef
  • Janus kinase inhibitors in the management of acute severe ulcerative colitis: a comprehensive review
    Javier P Gisbert, María Chaparro
    Journal of Crohn's and Colitis.2025;[Epub]     CrossRef
  • Sequential rescue therapy with JAK inhibitors in corticosteroid and infliximab-refractory acute severe ulcerative colitis: a case series
    Amirah Etchegaray, George Tambakis, Rina Kumar, Anthony Croft, Graham Radford-Smith, Gareth J. Walker
    Therapeutic Advances in Gastroenterology.2025;[Epub]     CrossRef
  • Population Pharmacokinetic Model for the Use of Intravenous or Subcutaneous Infliximab in Patients with Inflammatory Bowel Disease: Real-World Data from a Prospective Cohort Study
    Joo Hye Song, Sung Noh Hong, Myeong Gyu Kim, Minjung Kim, Seong Kyung Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim
    Gut and Liver.2025; 19(3): 376.     CrossRef
  • Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
    Yoon Suk Jung
    Intestinal Research.2025; 23(4): 394.     CrossRef
  • Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice
    Javier P Gisbert, María Chaparro
    Inflammatory Bowel Diseases.2025;[Epub]     CrossRef
  • Recent Advances in the Management of Acute Severe Ulcerative Colitis
    Elaine Ong Ming San, Kassem Sharif, Konstantina Rosiou, Michael Rennie, Christian Philipp Selinger
    Journal of Clinical Medicine.2024; 13(23): 7446.     CrossRef
  • 11,616 View
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  • 10 Web of Science
  • 10 Crossref
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Tacrolimus for the Treatment of Ulcerative Colitis
Katsuyoshi Matsuoka, Eiko Saito, Toshimitsu Fujii, Kento Takenaka, Maiko Kimura, Masakazu Nagahori, Kazuo Ohtsuka, Mamoru Watanabe
Intest Res 2015;13(3):219-226.   Published online June 9, 2015
DOI: https://doi.org/10.5217/ir.2015.13.3.219
AbstractAbstract PDFPubReader

Tacrolimus is a calcineurin inhibitor used for the treatment of corticosteroid-refractory ulcerative colitis (UC). Two randomized controlled trials and a number of retrospective studies have assessed the therapeutic effect of tacrolimus in UC patients. These studies showed that tacrolimus has excellent short-term efficacy in corticosteroid-refractory patients, with the rates of clinical response ranging from 61% to 96%. However, the long-term prognosis of patients treated with tacrolimus is disappointing, and almost 50% of patients eventually underwent colectomy in long-term follow-up. Tacrolimus can achieve mucosal healing in 40-50% of patients, and this is associated with a favorable long-term prognosis. Anti-tumor necrosis factor (TNF)-α antibodies are another therapeutic option in corticosteroid-refractory patients. A prospective head-to-head comparative study of tacrolimus and infliximab is currently being performed to determine which treatment is more effective in corticosteroid-refractory patients. Several retrospective studies have demonstrated that switching between tacrolimus and anti-TNF-α antibody therapy was effective in patients who were refractory to one of the treatments. Most adverse events of tacrolimus are mild; however, opportunistic infections, especially pneumocystis pneumonia, are the most important adverse events, and these should be carefully considered during treatment. Several issues on tacrolimus treatment in UC patients remain unsolved (e.g., use of tacrolimus as remission maintenance therapy). Further controlled studies are needed to optimize the use of tacrolimus for the treatment of UC.

Citations

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    Shiying Wu, Fangtong Wei, Yongqiang Chen, Ziqi Chen, Yuenuo Luo, Jiayi Fan, Yang Xu, Mingyang Hu, Ping Li, Qing Gu
    Probiotics and Antimicrobial Proteins.2025; 17(6): 5195.     CrossRef
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    Lynna Chen, Ashish Srinivasan, Suet‐Wan Choy, Jeffrey Van, Habeeb Habeeb, Andrew Nguyen, Abhinav Vasudevan
    Alimentary Pharmacology & Therapeutics.2025; 62(4): 400.     CrossRef
  • A Clinical Prediction Model for Early Colectomy in Patients With Severe Ulcerative Colitis Treated With Tacrolimus
    Hikaru Shimizu, Kazuki Kakimoto, Mai Utsumi, Suzune Sugishima, Hideaki Mitooka, Noboru Mizuta, Ryosuke Yamaguchi, Masatoshi Kaizuka, Koji Nishida, Keijiro Numa, Naohiko Kinoshita, Kei Nakazawa, Ryoji Koshiba, Yuki Hirata, Takako Miyazaki, Shiro Nakamura,
    JGH Open.2025;[Epub]     CrossRef
  • Current Approaches to Ulcerative Colitis Management: A Comprehensive Overview of Methodologies and Treatments
    Aman Rawat, Richa Srivastava
    Infectious Disorders - Drug Targets.2025;[Epub]     CrossRef
  • Predictive Factors for Efficacy of Oral Tacrolimus Induction Therapy in Moderate to Severe Ulcerative Colitis Patients: Large Multicenter Retrospective Cohort Study
    Naoki Oshima, Sakiko Hiraoka, Ryohei Hayashi, Sakuma Takahashi, Manabu Ishii, Shinichi Hashimoto, Kazuo Yashima, Shoko Igawa, Toshihiro Inokuchi, Yoshitaka Ueno, Tomoki Inaba, Hiroshi Matsumoto, Kousaku Kawashima, Taro Takami, Hajime Isomoto, Akiko Shiota
    Inflammatory Bowel Diseases.2024; 30(7): 1087.     CrossRef
  • RETRACTED ARTICLE: Exploring the therapeutic potential of Anastatica hierochuntica essential oil in DSS-induced colitis
    Abdelrahim Alqudah, Esam Qnais, Omar Gammoh, Yousra Bseiso, Mohammed Wedyan, Mohammed Alqudah, Muna Oqal, Rawan Abudalo, Shtaywy S. Abdalla
    Inflammopharmacology.2024; 32(3): 2035.     CrossRef
  • Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Review
    Javier P Gisbert, María José García, María Chaparro
    Journal of Crohn's and Colitis.2023; 17(6): 972.     CrossRef
  • Gastrointestinal tract and viral pathogens
    Gowthami Sai Kogilathota Jagirdhar, Yashwitha Sai Pulakurthi, Himaja Dutt Chigurupati, Salim Surani
    World Journal of Virology.2023; 12(3): 136.     CrossRef
  • Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection
    Ting Xue, Xiaomei Kong, Liang Ma
    Journal of Fungi.2023; 9(8): 812.     CrossRef
  • Cross-tissue transcriptome-wide association studies identify susceptibility genes shared between schizophrenia and inflammatory bowel disease
    Florian Uellendahl-Werth, Carlo Maj, Oleg Borisov, Simonas Juzenas, Eike Matthias Wacker, Isabella Friis Jørgensen, Tim Alexander Steiert, Saptarshi Bej, Peter Krawitz, Per Hoffmann, Christoph Schramm, Olaf Wolkenhauer, Karina Banasik, Søren Brunak, Stefa
    Communications Biology.2022;[Epub]     CrossRef
  • Discovery of a Colon-Targeted Azo Prodrug of Tofacitinib through the Establishment of Colon-Specific Delivery Systems Constructed by 5-ASA–PABA–MAC and 5-ASA–PABA–Diamine for the Treatment of Ulcerative Colitis
    Jiaxing Zhao, Bing Zhang, Qing Mao, Kunqi Ping, Peng Zhang, Fengwei Lin, Dan Liu, Yao Feng, Ming Sun, Yan Zhang, Qiu Hua Li, Tingjian Zhang, Yanhua Mou, Shaojie Wang
    Journal of Medicinal Chemistry.2022; 65(6): 4926.     CrossRef
  • Tacrolimus (FK506) for induction of remission in corticosteroid-refractory ulcerative colitis
    Morris Gordon, Vassiliki Sinopoulou, Anthony K Akobeng, Mirela Pana, Rehab Gasiea, Gordon William Moran
    Cochrane Database of Systematic Reviews.2022;[Epub]     CrossRef
  • Combination tacrolimus and ustekinumab therapy is effective in inducing clinical, biochemical and endoscopic remission in refractory moderate to severe ulcerative colitis
    Rachit Gupta, Julien D. Schulberg, Ola Niewiadomski, Emily K. Wright
    Autoimmunity Reviews.2022; 21(7): 103115.     CrossRef
  • Inpatient Therapy With Calcineurin Inhibitors in Severe Ulcerative Colitis
    Sujaata Dwadasi, Maryam Zafer, Donald Goens, Raghavendra Paknikar, Sushila Dalal, Russell D Cohen, Joel Pekow, David T Rubin, Atsushi Sakuraba, Dejan Micic
    Inflammatory Bowel Diseases.2021; 27(10): 1620.     CrossRef
  • Treatment of acute severe ulcerative colitis
    Jun-Rong Li, Fang-Mei Ling, Yi-Dong Chen, Ming-Yang Xu, Liang-Ru Zhu
    World Chinese Journal of Digestology.2021; 29(2): 87.     CrossRef
  • Role of Topical Tacrolimus in the Management of Proctitis, Perianal Manifestations in Crohn's Disease, and Chronic Pouchitis: A Systematic Review
    George Salem, Kai Ding, Atsushi Sakuraba, Russell Cohen
    Journal of Investigative Medicine.2021; 69(4): 796.     CrossRef
  • The Optimal Dose of Tacrolimus in Combination Therapy with an Anti-TNFα Antibody in a Mouse Colitis Model
    Yuki Murakami, Mikihiro Fujiya, Hiroaki Konishi, Shotaro Isozaki, Yuya Sugiyama, Yu Kobayashi, Takahiro Sasaki, Takehito Kunogi, Keitaro Takahashi, Katsuyoshi Ando, Nobuhiro Ueno, Shin Kashima, Kentaro Moriichi, Hiroki Tanabe, Toshikatsu Okumura
    Biological and Pharmaceutical Bulletin.2021; 44(4): 564.     CrossRef
  • Combination of Vedolizumab With Tacrolimus Is More Efficient Than Vedolizumab Alone in the Treatment of Experimental Colitis
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    Inflammatory Bowel Diseases.2021; 27(12): 1986.     CrossRef
  • The impact of cytochrome P450 3A genetic polymorphisms on tacrolimus pharmacokinetics in ulcerative colitis patients
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    PLOS ONE.2021; 16(4): e0250597.     CrossRef
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    Canadian Journal of Physiology and Pharmacology.2021; 99(10): 1069.     CrossRef
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  • 41 Web of Science
  • 45 Crossref
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