Is Infliximab safe in ulcerative colitis if steroids fail?

Question

Hello doctor,

I am writing on behalf of my father, who is 61 and was recently hospitalized for a severe flare of ulcerative colitis. He was given IV steroids in the hospital for five days and sent home with oral Prednisolone 40 mg, but it has been three weeks, and the bleeding is still not fully stopped.

He is going to the toilet at least eight times at night and looks completely exhausted. His albumin level is 2.4 g/dL, which the doctor said is very low, and his potassium was 3.1 mmol/L last week.

He is also diabetic, and the steroids have pushed his sugar levels to above 280 mg/dL consistently now, which his endocrinologist is very worried about. The two doctors do not seem to be coordinating much, and we feel lost in the middle.

He also has mild hypertension and is on Amlodipine 5 mg. Someone mentioned Infliximab as an option. Is that safe for someone with diabetes and high blood pressure?

Also, there is a small shadow on his recent chest X-ray that the pulmonologist wants to investigate before starting any biologic, and we do not know if we should wait or start treatment. The ulcerative colitis seems to be winning right now, and we are very scared.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your father appears to have severe active ulcerative colitis that is not adequately responding to steroids. Persistent bleeding, eight bowel movements at night, exhaustion, and low albumin (2.4 g/dL) suggest significant inflammation and protein loss from the colon. His low potassium (3.1) also needs correction because frequent diarrhea can cause electrolyte imbalance and weakness.

If symptoms persist after three to five days of intravenous steroids or several weeks of oral steroids, doctors consider this steroid-refractory disease, and escalation of therapy is usually required.

One effective option is Infliximab, a biologic that targets inflammation. It is commonly used when steroids fail and can help induce remission.

Infliximab can generally be used in patients with diabetes or hypertension, but infections must be ruled out first. That is why doctors are cautious about the shadow on the chest X-ray, as biologics can suppress immune responses.

They usually investigate infections such as tuberculosis before starting treatment. Meanwhile, the high blood sugars from Prednisolone are a known steroid side effect and often require temporary adjustment of diabetes medications or insulin under endocrinology guidance.

At this stage, the priorities are:

Correct potassium and nutritional status.
Evaluate the chest finding quickly to rule out infection.
Decide on biologic rescue therapy if steroids are failing.

Close coordination between gastroenterology, endocrinology, and pulmonology is important. With timely escalation of therapy, many patients with severe flares can still achieve good disease control and recovery.

I hope you are satisfied with my answer. Revert in case of further queries.

Thank you.