Recent Clinical Trials in Acute Severe Ulcerative Colitis: Can We Improve the Chances of Success of Corticosteroids and Rescue Therapies?

Thilini Delungahawatta; Neeraj Narula

doi:10.58931/cibdt.2026.4154

Authors

Thilini Delungahawatta, MD, MSc
Neeraj Narula, MD

Abstract

Key Takeaways

1. Don’t withhold intravenous (IV) steroids waiting for the stool infectious workup to come back. Many patients with infectious etiologies for exacerbation will require antimicrobials plus steroids to manage severe relapses.

2. When considering infliximab rescue therapy, a 10 mg/kg dose likely leads to higher response rates among patients with hypoalbuminemia (<25 g/L) and elevated CRP (≥50 mg/L) than a 5 mg/kg dose

3. JAK inhibitors can be considered as an adjunct to IV steroids, or as rescue therapy in steroid-refractory patients with a history of anti-TNF failure.

Author Biographies

Thilini Delungahawatta, MD, MSc

Dr. Thilini Delungahawatta is a Gastroenterology resident at McMaster University. She earned a Master of Science degree from McMaster University, completed her medical degree at the University of Limerick (Limerick, Ireland), and subsequently trained in Internal Medicine at MedStar Health–Georgetown University (MD, USA), where she participated in the Health Equity Track. Her academic interests now focus on inflammatory bowel disease (IBD), with particular emphasis on health equity and improving clinical outcomes in IBD populations.

Neeraj Narula, MD

Dr. Neeraj Narula is an Associate Professor of Medicine at McMaster University and Staff Gastroenterologist at Hamilton Health Sciences, with a clinical and research focus in Inflammatory Bowel Diseases (IBD). He is the director of the IBD clinic and IBD fellowship program at McMaster University. He completed the Present-Levison Advanced Inflammatory Bowel Diseases Fellowship at Mount Sinai Hospital (New York, NY) in 2015 and a Masters of Public Health at Harvard TH Chan School of Public Health (Boston, MA) in 2018. He has over 190 peer-reviewed publications and 4 book chapters. He has been awarded over $4 million in research funding and grants. His research interests are predominantly in clinical epidemiology, nutrition, and pharmaceutical trials in IBD. He has held leadership roles in national organizations including Past‑President of the Canadian IBD Research Consortium and VP-Treasurer for the Canadian Association of Gastroenterology (CAG). His recent awards include the CAG Early Career Investigator Award (2025), the Canadian IBD Research Consortium Distinguished Achievement Award (2025), Crohn’s and Colitis 360 Research Award (2025) and the McMaster Mid-Career Research Award (2025).

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Recent Clinical Trials in Acute Severe Ulcerative Colitis: Can We Improve the Chances of Success of Corticosteroids and Rescue Therapies?

Authors

Abstract

Author Biographies

Thilini Delungahawatta, MD, MSc

Neeraj Narula, MD

References

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