Table 3

Appropriateness of treatment options in acute severe UC in the context of the COVID-19 pandemic: rescue therapy

Rescue therapyFailure of rescue therapy
Negative SARS-CoV-2 swab WITHOUT respiratory symptomsContinue intravenous steroids aloneIFX +steroidsIntravenous ciclosporin +steroidsColectomyDelay surgery
IFX, stop steroidsIntravenous ciclosporin, stop steroidsDiscussion with COVID-19 specialist*
Positive SARS-CoV-2 swab WITHOUT respiratory symptoms or signs of COVID-19 pneumoniaContinue intravenous steroids aloneIFX +steroidsIntravenous ciclosporin +steroidsColectomyDelay surgery
IFX, stop steroidsIntravenous ciclosporin, stop steroidsDiscussion with COVID-19 specialist*
Positive SARS-CoV-2 swab WITH symptoms or signs of COVID-19 pneumoniaContinue intravenous steroids aloneIFX +steroidsIntravenous ciclosporin +steroidsColectomyDelay surgery
IFX, stop steroidsIntravenous ciclosporin, stop steroidsDiscussion with COVID-19 specialist*
  • Green is considered appropriate, yellow uncertain and red inappropriate. Steroids, intravenous hydrocortisone 100 mg four times daily or intravenous methylprednisolone 60 mg daily as an inpatient; IFX (either 5 mg/kg or 10 mg/kg).

  • *Discussion with appropriate COVID-19 specialist as per local availability.

  • IFX, infliximab.