Maneuvering Clinical Pathways for Ulcerative Colitis

  • Christopher M. Johnson
  • Catherine D. Linzay
  • Themistocles DassopoulosEmail author
Inflammatory Bowel Disease (S Hanauer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Inflammatory Bowel Disease


Purpose of Review

Recent years have brought about several advances in the treatment of patients with ulcerative colitis (UC). Here, we discuss salient recommendations of recent treatment guidelines; review the efficacy, safety, and real-world data of vedolizumab and tofacitinib; appraise their place vis-à-vis established agents; and consider the newly proposed approaches of risk-stratified and treat-to-target therapy.

Recent Findings

Once daily oral mesalamine dosing is equivalent to split dosing in mild–moderate UC. Real-world data are accumulating on the effectiveness and safety of vedolizumab for moderate to severe UC, while there are few such data on the most recently approved agent, tofacitinib. High-dose infliximab is being investigated for severe UC. New approaches are challenging the established paradigm of selecting therapy based on current disease activity. The risk-stratified approach incorporates long-term risk as well as the current burden of inflammation. The treat-to-target approach aims at improved long-term outcomes by adjusting therapy to resolve intestinal inflammation.


The therapeutic options for UC are continually expanding. Risk-stratified therapy and the treat-to-target approach represent paradigm shifts in UC management. Optimal disease control requires an individualized approach that takes into consideration current inflammatory burden, long-term risk, patient preferences, and ongoing assessment of response to treatment.


Ulcerative colitis Inflammatory bowel disease Vedolizumab Tofacitinib 


Compliance with Ethical Standards

Conflict of Interest

Christopher M. Johnson, Catherine D. Linzay, and Themistocles Dassopoulos declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christopher M. Johnson
    • 1
  • Catherine D. Linzay
    • 2
  • Themistocles Dassopoulos
    • 2
    • 3
    Email author
  1. 1.Baylor Scott and White Medical CenterBaylor Scott and White HealthTempleUSA
  2. 2.Baylor University Medical CenterBaylor Scott and White HealthDallasUSA
  3. 3.Baylor Scott and White Center for Inflammatory Bowel DiseasesDallasUSA

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