New Set of Guidelines to Improve Ulcerative Colitis Treatment?

Researchers from Canada recently published an updated set of guidelines for patients afflicted with mild-to-severe Ulcerative colitis (UC).

 

Developed to assist physicians in implementing the latest therapeutic treatment options, the guidelines were released by The Toronto Ulcerative Colitis Consensus Group.

 

Upon completing a thorough literature review, the group published 34 clauses focused on current UC therapeutic options, including administration of 5-aminosalicylate, corticosteroids, immunosuppressants, anti-tumor necrosis factor agents and other therapies (Entyvio [vedolizumab, Takeda Pharmaceuticals], fecal microbiota transplantation, and probiotics).

 

The team noted treatment with existing agents should be fine, so long as administration of corticosteroids is eliminated. According to the researchers, “Previous Canadian recommendations have addressed severe UC it he hospitalized patient, and these guidelines present recommendations for the non-hospitalized patient with mild-to-severe active UC. These guidelines should help optimize the use and proper positioning of existing medical therapies and, thus, improve outcomes in patients with UC.”

 

It wasn’t easy for the Canadian group to successfully publish the new set of guidelines. In fact, they experienced much criticism from Ashwin N. Ananthakrishnan, MD, MBBS, MPH, Massachusetts General Hospital and Harvard Medical School, and Sunanda V. Kane, MD, Mayo Clinical, Rochester, Minnesota regarding two key points:

 

·         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 immunomodulators-biologic therapy when using anti-TNF agents due to lower rates of antibody formation and subsequent improved response.

 

Additionally, experts noted a few areas where the consensus statement was unable to offer clear guidance, which requires further investigation: optimal duration of combination therapy along with biologics, the time and safety related to withdrawal of immunomodulators from combination therapy involving corticosteroid-free remission, mucosal healing, optimal methods for patient monitoring, characterization of risks at different aspects of treatment, prognostic biomarkers, individual treatment algorithms, therapeutic drug monitoring and alternatives to endoscopic assessment of disease control.

 

Authors concluded, “Finally, one can hope that we would have many more comparative effectiveness studies to guide us in the selection of specific treatments as well as trials of strategy that will inform their optimal positioning.”