A 37-year-old woman with extensive ulcerative colitis presents a severe flare-up for which treatment with prednisone at a dose of 1 mg/kg is started. After one week of treatment, the patient shows no improvement. What is the next therapeutic measure to be taken?
When a severe flare does not respond to iv corticosteroid therapy at full doses (1mg/kg body weight), it is necessary to switch to cyclosporine or infliximab. Etanercept is not approved in Europe for inflammatory bowel disease (for the time being).
Emergency subtotal colectomy and in a second time prostectomy and ileoanal reservoir.
Associate an immunosuppressant such as azathioprine.
Associate mesalazine in doses of 4g per day orally and rectal triamcinolone 1 application every 12 hours.
Intravenous cyclosporine 2mg/kg.
Treatment with etanercept (an anti-TNFa antibody) should be considered.
When a severe flare does not respond to iv corticosteroid therapy at full doses (1mg/kg body weight), it is necessary to switch to cyclosporine or infliximab.
Etanercept is not approved in Europe for inflammatory bowel disease (for the time being).