Treatment of severe acute ulcerative colitis in SARS-CoV-2 infected patients: report of three cases and discussion of treatment options

Arno R. Bourgonje, Reinier C. A. van Linschoten, Rachel L. West, Maarten A. van Dijk, Coretta van Leer-Buter, Gürsah Kats-Ugurlu, Marieke J. Pierik, Eleonora A. M. Festen, Rinse K. Weersma, Gerard Dijkstra

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In the wake of the COVID-19 pandemic, it is unclear how asymptomatic SARS-CoV-2-infected patients who present with acute severe ulcerative colitis (UC) can effectively and safely be treated. Standard treatment regimens consist of steroids, immunomodulatory drugs, and biological therapies, but therapeutic decision-making becomes challenging as there are uncertainties about how to deal with these drugs in patients with COVID-19 and active UC. Importantly, guidelines for this particular group of patients with UC are still lacking. To inform therapeutic decision-making, we describe three consecutive cases of patients with active UC and COVID-19 and discuss their treatments based on theoretical knowledge, currently available evidence and clinical observations. Three patients were identified through our national IBD network (Initiative on Crohn’s and Colitis, ICC) for whom diagnosis of SARS-CoV-2-infection was established by RT-PCR testing in nasopharynx, stools and/or biopsies. Acute severe UC was diagnosed by clinical parameters, endoscopy and histopathology. Clinical guidelines for SARS-CoV-2-negative patients advocate the use of steroids, calcineurin inhibitors or TNF-α-antagonists as induction therapy, and experiences from the current three cases show that steroids and TNF-α-antagonists could also be used in patients with COVID-19. This could potentially be followed by TNF-α-antagonists, vedolizumab or ustekinumab as maintenance therapy in these patients. Future research is warranted to investigate if and which immunomodulatory drugs should be used for COVID-19 patients that present with active UC. To answer this question, it is of utmost importance that future cases of patients with UC and COVID-19 are carefully documented in international registries, such as the SECURE-IBD registry.
Original languageEnglish
Number of pages35
JournalTherapeutic advances in gastroenterology
Publication statusPublished - 29-Apr-2021

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