Figure 7
IV Steroids
IV steroid-induced remission
maintenance options:
• Thiopurine
• Anti-TNF, with or without
thiopurine
b, c
• Vedolizumab, with or without
immunomodulator
d
IV steroid failure options:
• Infliximab
• Cyclosporine
• Colectomy
Infliximab
Infiximab-induced remission
maintenance:
• Infliximab with or without
Thiopurine
b, c
Infliximab failure
e
:
• Colectomy
IV Cyclosporine
IV Cyclosporine-induced remission
maintenance options:
• Start thiopurine
• Anti-TNF, with or without thiopurine
b, c
• Vedolizimab, with or without
immunomodulator
d
IV cyclosporine failure
e
:
• Colectomy
a
All hospitalized patients should receive prophylaxis for venous thromboembolism.
b
Combination therapy with a thiopurine is more efficacious than anti-TNF monotherapy and should
be considered, especially in patients who have failed one or more anti-TNF agents.
c
Extrapolating from data in Crohn's disease, methotrexate may be used instead of thiopurines to
decrease anti-TNF immunogenicity.
d
Extrapolating from data with anti-TNF agents, thiopurines and methotrexate may be used to
decrease vedolizumab immunogenicity.
e
Sequential rescue therapy (IFX-CSA or CSA-IFX) may be considered for select patients only in
centers with experience with this approach and recognizing the risks of severe infection and death.
Inductive Therapy
a
Options:
• IV steroids
• Infliximab
• IV cyclosporine
Colitis
