Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies.

Acute severe ulcerative colitis (ASUC) occurs in up to 25% of patients with ulcerative colitis (UC). Therapeutic approaches have evolved during the past years with the increasing bio exposure of admitted patients and the extension of the number of approved drugs for UC. In this review, we aimed to summarize the latest evidence in short-term and long-term medical strategies for ASUC. In addition to general principles such as venous thromboembolism prophylaxis, screening for triggering and worsening factors and close monitoring, first-line therapy for ASUC remains intravenous corticosteroids. In naive patients, the optimum maintenance strategy for steroid-responding patients does not necessarily include biologics. Second-line therapy includes infliximab or calcineurin inhibitors (CNIs) with similar short- and long-term colectomy rates. Despite its pathophysiological relevance, there is insufficient evidence to promote intensified induction with infliximab. Prior treatment exposure is a cornerstone for guiding therapeutic choice of short- and long-term therapies in the context of ASUC: in anti-TNF exposed patients, CNIs may be favored as a bridge therapy to vedolizumab or ustekinumab. Third-line salvage therapy could be a therapeutic option in selected patients referred to expert centers. Additionally, evidence is accumulating regarding the use of tofacitinib in ASUC.

Making protocols available with the article improved evaluation of selective outcome reporting.

OBJECTIVE: To compare primary outcomes reported in publications, protocols and registries and to evaluate the contribution of available protocols to assess selective outcome reporting (SOR) as compared with registration alone. STUDY DESIGN AND SETTING: We included all randomized controlled trials (RCTs) published in 2015 and 2016 in the five leading general medical journals. For each RCT, we evaluated whether the protocol was available and searched for registration. We extracted all primary outcomes reported in publications, registries, and protocols. We evaluated whether SOR was suspected (i.e., at least one discrepancy in primary outcomes), unclear, or not suspected based on comparisons of publications and (1) trial registration alone or (2) protocols in addition to registration. RESULTS: Selective outcome reporting was suspected for 77/274 (28.1%), unclear for 30 (10.9%), and not suspected for 167 (60.9%) when comparing publications and trial registration alone. With protocols available, the classification changed for 38 RCTs (13.9%): 11 not suspected of SOR based on registration became suspected of SOR with protocols available, and 27 with unclear assessment based on registration became suspected of SOR (n = 7) and not suspected of SOR (n = 20) with protocols available. CONCLUSIONS: Compared to registration alone, making protocols available allows for a more precise evaluation of SOR.