Inclusion criteria:
Be able to give informed consent.
Known case of moderate to severe Ulcerative Colitis as Mayo score ≥6 or Sigmoidoscopy Sub Score ≥2 and expansion ≥2 15cm from Anal Verge with at least one of the followings: CRP≥ 2.87 mg/L or ≥ 3 large ulcers in colonoscopy or ≥ 10 aphthous ulcer or stool calprotectin ≥ 250 mg/gr
No clinical response or clinical remission (failed treatment) after ant TNF defined as: 1- Signs and symptoms of stable active disease despite taking more than or equal to 14 weeks of the following medication regimens 1-1)infliximab 5mg/kg IV at least 2 doses with 2 weeks interval 1-2) adalimumab 80 mg SC first dose then 40 mg SC with 2 weeks intervals 1-3) Recurrence of symptoms after initial recovery when the patient is on anti-TNF maintenance therapy 2- History of intolerance to at least one type of Anti-TNF drug, including injection-induced allergies, demyelination, infection, and congestive heart failure.
Be able to use less than 30 mg per day prednisolone or 9mg per day budesonide, immunosuppressants (Azaram, 6MP, MTX) or Mesalazine and antibiotics.
Exclusion criteria:
Symptoms of infection such as abdominal abscess or Toxic Mega Colon during patient visits
Surgery and removal of a large part of the intestine (complete or subtotal colectomy, history of more than 3 times surgery and resection of the small intestine or diagnosis of short bowel syndrome), symptomatic colonic stenosis, ostomy.
Ileostomy, colostomy, well-known symptoms of small bowel stenosis.
Use of Anti-TNF drugs 60 days before registration.
Use of cyclosporine, Thalidomide or research drugs within 30 days prior to registration.
Previously been treated with drugs such as Rituximab, Natalizumab Vedolizumab
Chronic hepatitis B or C infection
Clostridium difficile infection during the last 60 days
Active or latent tuberculosis
Do not have the results of TB diagnostic test.
Amoebiasis trophozoite infection in fecal examination
Immune deficiency (HIV infection or congenital immunodeficiency)
Has received live vaccines in the last 30 days.
Pregnancy or breastfeeding
An unstable or uncontrolled medical disorder that requires hospitalization or major surgery at the initial visit
A surgical procedure that required general anesthesia during the last 30 days
Existence of colon dysplasia
Any malignant cancer
WBC less than 3000
lymphocyte less than 500
platelet less than 100000 or more than 1200000
ALT or AST greater than 3 times the maximum normal value
ALP greater than 3 times the maximum normal value
Serum Cr more than 2 times the maximum normal value
Absence from all visits or non adherence to study protocol