This article is more than 5 years old. Information may no longer be current.
Experts release consensus guidelines for management of nonhospitalized ulcerative colitis
A Canadian consensus group has released clinical practice guidelines for the treatment of ambulatory patients with mild-to-severe active ulcerative colitis, updated to incorporate recently developed therapeutic agents and strategies.
“Previous Canadian recommendations have addressed severe UC in the hospitalized patient, and these guidelines present recommendations for the nonhospitalized patient with mild-to-severe active UC,” the authors wrote. “These guidelines should help to optimize the use and proper positioning of existing medical therapies and, thus, improve outcomes in patients with UC.”
The Toronto Ulcerative Colitis Consensus Group performed a systematic search of relevant literature published through June 2014, and used a modified Delphi process to develop 34 statements focused on five main treatment classes: 5-aminosalicylate, corticosteroids, immunosuppressants, anti-tumor necrosis factor agents and other therapies (Entyvio [vedolizumab, Takeda Pharmaceuticals], fecal microbiota transplantation and probiotics). They also developed an algorithm for the medical management of mild-to-severe UC, and defined the goal of therapy as “complete remission, including both symptomatic and endoscopic remission, with timely assessments of response and remission being a key factor in achieving this goal.” Remission should be maintained with continued therapy typically using the same agents used for induction with the exception of corticosteroids, they wrote.
Ashwin N. Ananthakrishnan
According to an accompanying editorial written by Ashwin N. Ananthakrishnan, MD, MBBS, MPH, from Massachusetts General Hospital and Harvard Medical School, and Sunanda V. Kane, MD, from Mayo Clinic in Rochester, Minnesota, the Toronto guidelines diverge from those preceding it in two key areas:
- They relegate immunomodulators to a secondary role “to be used either in combination with biologics and in those who achieve symptomatic remission on oral corticosteroids, recommending against their use as monotherapy in those with steroid-dependent disease.”
- They emphasize combination immunomodulator-biologic therapy when using anti-TNF agents due to lower rates of antibody formation and subsequent improved response.
According to the editorial, the consensus statement also fails to provide clear guidance for a number of areas, including “the optimal duration of combined therapy along with biologics or appropriate dose of immunomodulators,” the safety of withdrawing immunomodulators from combination therapy after a period of corticosteroid-free remission and mucosal healing, and specifics regarding optimal patient monitoring.
The consensus group concluded that besides optimal duration of combination therapy, further data are needed on “prognostic biomarkers, risk stratification, individualized treatment algorithms, therapeutic drug monitoring, and alternatives to endoscopy for assessing disease control,” as well as new therapies like “antagonists of leukocyte trafficking and Janus kinase inhibitors.” – by Adam Leitenberger
Disclosure: Bressler reports various financial relationships with Abbott/AbbVie, Alba Therapeutics, Alpco, Amgen, Bristol-Myers Squibb, Celltrion, Ferring, Genentech, GlaxoSmithKline, Hospira, Janssen, Millennium, Pendopharm, Pfizer, Shire, Takeda and Warner Chilcott. Please see the guideline for a full list of all other authors’ relevant financial disclosures. Ananthakrishnan reports he has consulted for AbbVie and Cubist Pharmaceuticals, and Kane reports he has consulted for AbbVie, Shire, Salix and UCB.