Moderately to Severely Active Ulcerative Colitis When Advanced Therapy Has Not Achieved Remission

This protocol addresses patients with moderately to severely active ulcerative colitis of any extent who have not reached adequate disease control after a course of advanced medical induction therapy.

Clinical scenario

Moderately to severely active ulcerative colitis of any extent, assessed after a prior course of advanced induction therapy and found to be refractory or intolerant to that medical treatment.

Prior treatment & failure condition

The previous protocol used advanced therapy for induction of remission — selecting from agents including ozanimod, etrasimod, ustekinumab, guselkumab, mirikizumab, risankizumab, vedolizumab, infliximab, adalimumab, golimumab, tofacitinib, or upadacitinib.

Targets not achieved at 6–12 weeks (triggering escalation)

Clinical remission with absence of rectal bleeding
Normalized stool frequency
Endoscopic improvement (Mayo endoscopic score 0 or 1)

Next-step approach (partial)

For patients refractory or intolerant to medical therapy, surgical consultation is recommended and colectomy is among the options considered — the full evidence-based protocol specifies the surgical approach of choice and the criteria guiding the decision to proceed.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000003463

Obtain consultation with a surgeon and consider colectomy in patients with moderately to severely active UC who are refractory or intolerant to medical therapy

Patients with moderately to severely active UC who do not maintain remission despite optimized medical therapy should be considered for elective proctocolectomy

Restorative proctocolectomy with ileal pouch anal anastomosis is currently the surgical procedure of choice for the management of refractory UC.

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