Biologicals in treatment of acute ulcerative colitis

Ulcerative colitis (UC) results from exaggerated immune response to gut flora in genetically predisposed individuals. Acute exacerbation of UC occurs in 12-58% of patients. About a fifth of these patients do not respond to intra-venous glucocorticoids, which is the standard treatment of this condition. Earlier, patients failing to respond to intra-venous glucocorticoids were treated with colectomy with its consequent disadvantages, such as low preference by the patients, need for surgical expertise, complications and even potential fatal outcome. However, currently these patients are quite effectively managed by immunomodulator treatment such as cyclosporin and biologicals. Since tumor necrosis factor a (TNF-α) is the major pro-inflammatory cytokine involved in the pathogenesis of IBD, monoclonal anti-TNF antibody, such as infliximab, has been studied most in management of IBD, including UC. This paper reviews the current data on biologicals in management of acute UC.