Week 6- Clinical therapeutics - IBD

Question 1

what is the aim for therapy?

Answer 1

• Reduce symptoms
• Induce remission
• Maintain remission
• Improve (maintain) the quality of life
• Minimise toxicity related to drugs (short and long-term)

Question 2

what is acute treatment?

Answer 2

ACUTE treatment is often termed INDUCTION treatment - i.e. to induce remission

Question 3

what is maintenance treatment?

Answer 3

MAINTENANCE therapy is that used to maintain remission/prevent relapse

Question 4

what affects the choice of therapy?

Answer 4

• Disease severity
• Disease extent
• Disease location (see article)
• Previous response to therapy
• Presence of complications

Question 5

what is ulcerative colitis that affects the rectum mild to moderate called?

Answer 5

proctitis

Question 6

what is the treatment for proctitis?

Answer 6

• Topical aminosalicylate (first presentation or inflammatory exacerbation) in the form of suppositories
• if remission not achieved in 4 weeks consider oral aminosalicylate
• If further treatment needed consider adding topical or oral corticosteroid for limited time

Question 7

what is ulcerative colitis called for mild to moderate affecteing left side of colon?

Answer 7

• distal colitis (left sided)

- proctosigmoiditis

Question 8

what is used to treat mild to moderate for PROCTOSIGMOIDITIS AND LEFT-SIDED COLITIS?

Answer 8

-Topical aminosalicylate (first presentation or inflammatory exacerbation) in the form of enema
-If remission not achieved in 4 weeks consider
• adding a high-dose oral aminosalicylate
• Switching to high-dose oral aminosalicylate and time limited topical corticosteroid

Question 9

what is ulcerative colitis called for mild to moderate affecteing extensive part of colon?

Answer 9

-Topical aminosalicylate and high-dose oral aminosalicylate (first presentation or
inflammatory exacerbation)
-If remission not achieved in 4 weeks, stop topical treatment and offer a time-limited
course of oral corticosteroids

Question 10

what is used to treat moderate to serve UC?

Answer 10

-oral corticosteroid

Question 11

what is used to treat moderate to serve UC which are active diseases?

Answer 11

-Infliximab, adalimumab, golimumab(TA 329) – after failure of conventional therapy

Question 12

what is used to treat acute serve UC?

Answer 12

-should be hospitalised
-likely hood of surgery should be constantly assessed
IV corticosteroids and assess likelihood of requiring surgery
• Consider IV ciclosporin or surgery in those intolerant/decline/CI corticosteroids
• If symptoms worsen or little/no improvement within 72 hours, consider adding IV
ciclosporin to the corticosteroid
• If ciclosporin CI/clinically inappropriate, infliximab is an option

Question 13

what is used to maintain remission therapy in mild to moderate for PROCTITIS and PROCTOSIGMOIDITIS?

Answer 13

Consider the following options:
• Topical aminosalicylate alone (daily or intermittent)
• Oral aminosalicylate plus topical aminosalicylate (daily or intermittent)
• Oral aminosalicylate – explaining that this may not be as effective as combined
treatment or intermittent topical aminosalicylate alone

Question 14

what is used to maintain remission therapy in all areas mild to moderate?

Answer 14

Consider mercaptopurine or azathioprine:
• After 2 or more inflammatory exacerbations in 12 months that require systemic corticosteroids
Or
• If remission is not maintained by aminosalicyates
• Consider azathioprine or mercaptopurine (or oral aminosalicylate if aza/merc CI)
• To maintain remission after a single episode of acute severe UC