Emerging treatments
Immunomodulators and biologic agents
Intravenous cyclosporine and infliximab are recommended as rescue therapy when corticosteroids do not resolve severe colitis associated with ulcerative colitis; their use can prevent surgery for at least 3 months in 60% to 80% of patients who have not responded to corticosteroids.[37][42] Anecdotal reports have described the successful treatment of toxic colitis/toxic megacolon (TC/TM) in one or two patients using cyclosporine, infliximab, or tacrolimus.[43][44][45][46][47] The role of these agents in the treatment of megacolon is unclear.
Leukocytapheresis (LCAP)
LCAP has been investigated as a treatment for inflammatory bowel disease (IBD). It is a selective apheresis aimed at reducing the number of circulating lymphocytes, with the goal of reducing cytokine and chemokine production thought to contribute to and perpetuate inflammation.[48] The available data are partially conflicting and published controlled trials are too small to draw definitive conclusions.[49] However, the results from one large prospective observational study suggest that LCAP is safe and effective (clinical remission rate 68.9% [429/623]) in patients with active ulcerative colitis, the majority of whom were corticosteroid-refractory.[50]
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