1. In adult outpatients with moderate-to-severe ulcerative colitis (UC), AGA recommends using infliximab, adalimumab, golimumab, vedolizumab, tofacitinib or ustekinumab over no treatment. (Medications are ordered based on year of approval by the U.S. FDA.)
2a. In adult outpatients with moderate-to-severe UC who are naïve to biologic agents, AGA suggests using infliximab or vedolizumab rather than adalimumab, for induction of remission.
2b. In adult outpatients with moderate-to-severe UC who are naïve to biologic agents, AGA recommends that tofacitinib only be used in the setting of a clinical or registry study.
2c. In adult outpatients with moderate-to-severe UC who have previously been exposed to infliximab, particularly those with primary nonresponse, AGA suggests using ustekinumab or tofacitinib rather than vedolizumab or adalimumab for induction of remission.
3a. In adult outpatients with active moderate-to-severe UC, AGA suggests against using thiopurine monotherapy for induction of remission.
3b. In adult outpatients with moderate-to-severe UC in remission, AGA suggests using thiopurine monotherapy rather than no treatment for maintenance of remission.
3c. In adult outpatients with moderate-to-severe UC, AGA suggests against using methotrexate monotherapy for induction or maintenance of remission.
4a. In adult outpatients with active moderate-to-severe UC, AGA suggests using biologic monotherapy (tumor necrosis factor (TNF)-α antagonists, vedolizumab or ustekinumab) or tofacitinib rather than thiopurine monotherapy for induction of remission.
4b. In adult outpatients with moderate-to-severe UC in remission, AGA makes no recommendation in favor of or against using biologic monotherapy or tofacitinib rather than thiopurine monotherapy for maintenance of remission.
5a. In adult outpatients with moderate-to-severe UC, AGA suggests combining TNF-α antagonists, vedolizumab or ustekinumab with thiopurines or methotrexate rather than biologic monotherapy.
5b. In adult outpatients with moderate-to-severe UC, AGA suggests combining TNF-α antagonists, vedolizumab or ustekinumab with thiopurines or methotrexate rather than thiopurine monotherapy.
6. In adult outpatients with moderate-to-severe UC, AGA suggests early use of biologic agents with or without immunomodulator therapy rather than gradual step up after failure of 5-aminosalicylate (5-ASA).
7. In adult outpatients with moderate-to-severe UC who have achieved remission with biologic agents and/or immunomodulators or tofacitinib, AGA suggests against continuing 5-ASA for induction and maintenance of remission.
8. In hospitalized adult patients with acute severe ulcerative colitis (ASUC), AGA suggests using intravenous methylprednisolone dose equivalent of 40–60 mg/d rather than higher doses of intravenous corticosteroids.
9. In hospitalized adult patients with acute severe UC without infection, AGA suggests against adjunctive antibiotics.
10. In hospitalized adult patients with ASUC refractory to intravenous corticosteroids, AGA suggests using infliximab or cyclosporine.
11. In hospitalized adult patients with acute severe UC being treated with infliximab, AGA makes no recommendation on routine use of intensive vs. standard infliximab dosing.
