Concise Commentary: Second Line Is Not Second Best—Continuing Validity of the Oxford Criteria in the Management of Acute Severe Ulcerative Colitis

Excerpt

Acute severe ulcerative colitis (ASUC), as the most lethal complication of inflammatory bowel disease, often necessitates referral of patients to specialized centers staffed with trained medical and surgical teams [1]. First-line therapy is intravenous (IV) steroids, justified by over 50 years of experience that has documented the induction of clinical remission in ~ 65% of cases [2]. Cyclosporine or infliximab, used as second-line therapy, is effective in the setting of steroid resistance [3]. If the disease does not respond to this second-line therapy or at any time when peritoneal symptoms are manifest, colectomy is indicated. Surgery is also often indicated in initial responders if the disease relapses after a short period of time; ~ 20–30% of relapsers require colectomy at 1 year [4]. Until now, modifying the infusion schedule or doses has not been associated with significant improvement [5]. …