Editorial: what can be done when infliximab stops working in ulcerative colitis?

Currently the clinician managing secondary loss of anti‐tumour necrosis factor (TNF)‐α response in ulcerative colitis (UC) is faced with a difficult dilemma. Should he/she escalate the anti‐TNFα dose, switch to an alternative anti‐TNFα or biological (e.g. vedolizumab), initiate a thiopurine (if naïve to this) or a course of glucocorticosteroids or consider surgery as a curative option? In a progressively unwell individual with a severe flare, the window for decision‐making is narrow. More broadly, what is the threshold for anti‐TNFα (or any biologic) in UC and what is the long‐term exit strategy of those maintained on anti‐TNFα therapies if they are stable in remission or experience a flare, and what is the most cost‐effective approach?