You ensure that all opiates, anticholinergics, and NSAIDs are not prescribed and confirm that appropriate pharmacologic venous thromboembolism prophylaxis has been prescribed and is being administered.
After 3 days of IV steroids, he is still having 8 bloody bowel movements per day. Repeat labs are significant for Hgb 9.5, albumin 2.6 g/dL, ESR 35, CRP 52. Hepatitis B sAb positive, sAg negative, cAb negative, PPD is read and is negative.
What is your next treatment?
Adalimumab 160 mg
Adalimumab has not shown efficacy in severe to fulminant ulcerative colitis
Vedolizumab 300mg IV
Vedolixumab has not shown efficacy in severe to fulminant ulcerative colitis
Tofacitinib 5mg PO BID
Tofacitinib may be effective in UC, however FDA guidance only allows use in anti-TNF failures due to side effect profile
Infliximab 5 mg/kg
Infliximab IV and Cyclosporine IV are the two approved rescue therapies for acute severe ulcerative colitis as they have the best data for use in steroid refractory hospitalized UC.
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