Impact of pandemic on management of ASUC

Impact of pandemic on management of ASUC

May 18, 2021

Issue 10

Clinical Question

How has the COVID-19 pandemic affected care of acute severe ulcerative colitis (ASUC) patients?

Editor’s Bottom Line

Clinicians managing ASUC during the pandemic adapted by using rescue therapy earlier and more often. It will be of interest to see whether these changes persist once the pandemic abates.


Sebastian S, Walker GJ, Kennedy NA, et al. Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study. Lancet Gastroenterol Hepatol. 2021;6(4):271–81;


Investigators at 60 acute secondary care hospitals in the United Kingdom documented changes in the management of patients with ASUC during the COVID-19 pandemic. Their analysis included 398 adults treated for ASUC during the pandemic (March–June 2020) and 384 ASUC patients treated before the pandemic (January–June 2019).

According to the findings, 46% of patients treated during the pandemic received biologics, cyclosporine or tofacitinib as rescue or primary induction treatment, compared to 36% of historical controls (p=0.0064). The time to rescue therapy was also shorter during the pandemic. Statistical analyses controlling for markers of ASUC severity did not affect the likelihood of rescue therapy during the pandemic.

Results also showed that 13% of patients received outpatient intravenous corticosteroids during the pandemic, compared to 5% in the pre-pandemic period (p=0.00023). Only 7% of patients treated during the pandemic received thiopurines, compared to 12% prior to the pandemic (p=0.029). Use of 5-aminosalicylic acid (5-ASA) drugs was also less common during the pandemic (17% vs. 26%; p=0.0037). While colectomy rates did not change during the pandemic, a laparoscopic approach was common during the pandemic period (53% vs. 76% of all surgeries; p=0.018).

Clinical outcomes and rates of hospitalization and surgeries at three months of follow-up did not differ between the pandemic and pre-pandemic groups.

Two percent of patients who underwent SARS-CoV-2 testing had a positive test and none experienced severe COVID-19 outcomes.


Study Design: Observational case-control

Funding: National Institute of Health Research Newcastle Biomedical Research Centre, Crohn’s and Colitis UK and the British Society of Gastroenterology

Allocation: None

Setting: Multicenter

Level of Evidence: 3b