Curbside Consultation in IBD: 49 Clinical Questions, Second Edition

David T Rubin, MD; Sonia Friedman, MD; Francis A Farraye, MD MSc

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Question 24: What Are The Relative Benefits Of Cyclosporine Or Infliximab In Severe Ulcerative Colitis? How Do You Choose Between The Two Options? (continued)

Seamus J. Murphy, MD, PhD; Asher Kornbluth, MD

Intravenous (IV) corticosteroids have been the mainstay of treatment for acute severe ulcerative colitis (UC) for more than 50 years. Patients not responding to this treatment (approximately 40% of all severe colitic patients) should be identified early so that discussions regarding future treatment (IV cyclosporine, infliximab, or surgery) can begin. IV cyclosporine is effective therapy in severe UC. Multiple series have replicated the 80% response rate in the acute phase first demonstrated by Lichtiger el al1 in 1994 in patients failing IV corticosteroids. We start…