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Assessment, endoscopy, and treatment in patients with acute severe ulcerative colitis during the COVID-19 pandemic (PROTECT-ASUC): a multicentre, observational, case-control study

Lookup NU author(s): Dr Sesha Subramanian, Dr Marcus Brookes, Dr Chris LambORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Background: There is a paucity of evidence to support safe and effective management of acute severe ulcerative colitis (ASUC) in the COVID-19 pandemic period. We sought to identify alterations in treatment paradigms of ASUC during the early COVID-19 pandemic, the impact on ASUC outcomes and any associations with SARS-CoV-2 infection and severe COVID-19 outcomes. Methods: A multicentre observational case control study of ASUC patients during the first wave of the COVID-19 pandemic in the United Kingdom, with comparison to a 2019 prepandemic historical cohort. Findings: We included 782 patients (398 in the pandemic period cohort and 384 in the historical control cohort) meeting the Truelove and Witts criteria for ASUC. The primary outcome of rescue therapy (including primary induction) or surgery was higher during the pandemic (55·2% [217/393] vs 41·8% [159/380] p=0·00024) and the time to the primary outcome was shorter (p = 0·0026). During the pandemic more patients received ambulatory (outpatient) intravenous steroids (13·2% [51/385] vs 5·3% [19/360] respectively, p=0·00023). During the pandemic, more patients received induction biologic therapy (either as rescue or primary therapy), ciclosporin or tofacitinib (45·7% [177/387] vs 35·9% [134/373], p=0·0064), there was lower use of thiopurines (7·3% [29/398] vs 12·0% [46/384], p=0·029) and 5-aminosalicylic acids (5-ASAs) (16·8% [67/398] vs 25·5% [98/384], p=0·0037). Whilst colectomy rates were similar between the pandemic and historical control groups (16·5% [64/389] vs 13·3% [50/375], p=0·26), laparoscopic surgery was less frequently performed during the pandemic period (53·1% [34/64] vs 76·0% [38/50], p=0·018). During the ASUC episode and by 3 months respectively, only 1·98% (5/253) and 1·94% (2/103) of patients were diagnosed with COVID-19 and none had serious COVID-19 outcomes (mechanical ventilation, ICU admission or death). Interpretation: The COVID-19 pandemic altered practice patterns of gastroenterologists and colorectal surgeons in the management of ASUC but was associated with similar ASUC outcomes to a historical cohort. Despite continued use of high dose corticosteroids and biologics the incidence of COVID-19 within 3-months was low and not associated with adverse COVID-19 outcomes.

Publication metadata

Author(s): Sebastian S, Walker GJ, Kennedy NA, Conley TE, Patel KV, Subramanian S, Kent AJ, Segal JP, Brookes MJ, Bhala N, Gonzalez HA, Hicks LC, Mehta SJ, Lamb CA

Publication type: Article

Publication status: Published

Journal: The Lancet Gastroenterology and Hepatology

Year: 2021

Volume: 6

Issue: 4

Pages: 271-281

Print publication date: 01/04/2021

Online publication date: 02/02/2021

Acceptance date: 04/01/2021

Date deposited: 04/01/2021

ISSN (electronic): 2468-1253

Publisher: Elsevier


DOI: 10.1016/S2468-1253(21)00016-9


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