UC treatment plans

Question 1

Mild-moderate active UC

Answer 1

4-6 stools/day

Minimal systemic symptoms

Question 2

Mild-moderate UC 1st line

Answer 2

Left sided disease–> topical mesalamine enema

Proctitis–> mesalamine suppository

Extensive disease–>oral mesalamine

Question 3

Mild-moderate unresponsive

Answer 3

Change formulation of mesalamine OR

High dose mesalamine (>3g/day) + rectal mesalamine

Budesonide CR–> LIMITED TO <8-16 weeks

Corticosteroids–> INDUCTION ONLY
-PO: refractory to mesalamine
-Topical: left-sided or proctitis

Question 4

Moderate-severe active UC

Answer 4

4-6 stools/day
Some systemic symptoms

Question 5

Moderate-severe 1st line

Answer 5

Systemic corticosteroid

Other: Budesonde CR–>MODERATE
Mesalamine–> MODERATE

PLUS

Biologics: When?
Unresponsive to therapy
Steroid dependent
Steroid refractory
If high risk for colectomy–>1st line option

Question 6

Monotherapy vs Combination therapy

Answer 6

TNF-inhibitors, vedolizumab, Ustekinumab + thiopurine/MTX

Reduces antibody development

Question 7

Severe-Fulminant Active UC

Answer 7

6-10 stools/day

Systemic symptoms

Question 8

Severe-Fulminant 1st line

Answer 8

IV corticosteroids (methylprednisolone or hydrocortisone) x 3-7 days

Question 9

Severe-Fulminant 2nd line

Answer 9

Infliximab or Cyclosporine

When? unresponsive to IV steroids

Question 10

Maintenance UC treatment

Answer 10

Depends on tx to induce remission

Mesalamine OR

TNF-inhibitor OR: pts who required TNF-inhib for induction or failed AZA/6-MP

Biologics OR

AZA/6-MP: pts who are steroid dependent or unresponsive to mesalamine

NO CORTICOSTEROIDS/CYCLOSPORINE