Week 6- ulcerative coltitis tharpeutics

Question 1

what are the aims for treatment?

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 does treat to target?

Answer 2

Adjustment to therapy based on assessment (control of asymptomatic inflammation)

Question 3

how is mild to moderate UC -proctitis treated?

Answer 3

• Topical aminosalicylate (first presentation or inflammatory exacerbation)
  • If remission not achieved in 4 weeks consider adding oral aminosalicylate
  • If further treatment needed consider adding topical or oral corticosteroid
  • Time limited
• For patients that decline topical treatment – consider oral aminosalicylate (not as
  effective)
• For patients that cannot tolerate aminosalicylates consider time limited oral or
  topical corticosteroid

Question 4

how is mild to moderate UC – PROCTOSIGMOIDITIS AND LEFT-SIDED COLITIS (DISTAL COLITIS) treated?

Answer 4

• Topical aminosalicylate (first presentation or inflammatory exacerbation)
• 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
• If further treatment needed, stop topical treatment and offer oral aminosalicylate and time
limited oral corticosteroid
• For patients that cannot tolerate aminosalicylates, consider time limited topical or oral
corticosteroid

Question 5

how is mild to moderate UC –EXTENSIVE treated?

Answer 5

• 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
• For people who cannot tolerate aminosalicylates, consider a time limited oral corticosteroid

Question 6

how is moderate to serve UC treated?

Answer 6

oral corticosteroid

Question 7

how is moderate to severe UC active disease treated?

Answer 7

• Biologics and Janus kinases
• Infliximab, adalimumab, golimumab(TA 329) – after failure of conventional therapy
• Vedolizumab – (TA 342) – inadequate response/loss of response (or intolerance) to
either conventional therapy or TNFalpha antagonists
• Tofacitinib (TA 574) – when the disease has responded inadequately/response been
lost, to conventional or biological therapy

Question 8

how to maintain in mild to moderate FOR- PROCTITIS and PROCTOSIGMOIDITIS UC?

Answer 8

• Maintaining remission – mild to moderate
- PROCTITIS and PROCTOSIGMOIDITIS
• 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 9

how to maintain in mild to moderate FOR- LEFT-SIDED and EXTENSIVE UC?

Answer 9

• Offer low maintenance dose of oral aminosalicylate

Question 10

how to maintain in mild to moderate for all areas?

Answer 10

• 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