Immunosuppressive treatment for refractory ulcerative colitis - where do we stand and where are we going?

Effective medical treatment of ulcerative colitis is available. However, 20-40% of patients remain refractory and become steroid dependent, or have chronic activity. Azathioprine and its metabolite 6-mercaptopurine have been found to be effective in this setting, although duration of treatment and doses are not entirely clear. Neither is widely used in Europe for this indication. Methotrexate has no definitive place in the treatment of refractory colitis. Intravenous cyclosporin A induces remission in a considerable number of patients; follow-up treatment is, however, not defined. This approach may be useful to allow elective surgery. A number of other treatments have been proposed including chloroquine, interferons and anti-cytokines. None of these can currently be recommended for clinical practice. Anti-inflammatory cytokines such as interleukin-10 may be good candidates.