What is the next step in the treatment of ulcerative colitis after failed oral prednisone and mesalamine?

The next step in the treatment of ulcerative colitis after failure of oral prednisone and mesalamine is the use of an anti-tumor necrosis factor alpha (TNF-alpha) agent such as infliximab. This choice is appropriate because when patients with ulcerative colitis do not respond to standard treatment options like oral corticosteroids and 5-aminosalicylic acid (mesalamine), biologic therapies targeting specific pathways in inflammation become a necessary option.

Infliximab works by inhibiting TNF-alpha, a critical cytokine involved in the inflammatory processes of ulcerative colitis. By reducing the activity of TNF-alpha, infliximab can help to achieve remission in patients who have not responded to conventional therapies. Additionally, infliximab has been shown to promote mucosal healing and has a favorable long-term safety profile, making it a suitable choice in the management of moderate to severe ulcerative colitis.

While other options may have potential roles in specific scenarios, they do not represent the most appropriate next step after the failure of the initial treatment. Topical steroids might be effective for localized disease but are not generally utilized when systemic treatment has failed. Immunosuppressants can be considered but typically are not