Ulcerative Colitis: best treatment practices revealed

Girl suffering with UC
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New AGA guidelines, published in Gastroenterology, suggest the best treatment practices for the optimum care of patients with moderate to severe UC

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that affects the large intestine. In a person with UC, the lining of the colon becomes inflamed and swollen. Untreated UC can lead to problems or other chronic conditions, such as bleeding in the stool, diarrhoea, severe dehydration and anaemia due to blood loss. UC is associated with an elevated risk of colorectal cancer.

The evidence-based document, published by AGA in Gastroenterology, highlighted 15 recommendations to improve treatments across the board. There are already several drugs available for the long-term management of UC, which brings up questions regarding treatment strategies to provide the best possible care.

The guidelines focus on immunomodulators, biologics, and small molecules to bring on and maintain remission for patients with moderate to severe UC and to decrease the risk of colectomy.

Joseph D. Feuerstein, lead author, said: “While there is no cure for ulcerative colitis, currently available therapies can help patients into remission, which means the patient feels well and does not show signs of inflammation. With so many drugs available, the question for many gastroenterologists is what is the right drug for my patient? This guideline takes a comprehensive and evidence-based look at available therapies to provide the most trusted guidance to-date on treatment options to ultimately improve the care of patients with moderate-to-severe UC.”

To see the full list of 15 recommendations review the full guidelines here. Some recommendations include:

  1. In adult outpatients with moderate to severe UC who are new to biologics, AGA suggests using infliximab or vedolizumab rather than adalimumab for induction of remission.
  2. In adult outpatients with moderate to severe UC who have been exposed to infliximab, particularly those who were not responsive, AGA suggests using ustekinumab or tofacitinib, rather than vedolizumab or adalimumab, for induction of remission.
  3. In adult outpatients with moderate to severe UC, AGA suggests early use of biologics with or without immunomodulator therapy, rather than a gradual step up after the failure of 5-aminosalicylates.

The recommendations made support AGA’s ongoing fight against step therapy treatment where insurers require patients to try and fail medications before agreeing to cover the initial therapy prescribed by their health care provider.

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