Maintenance of remission in patients with previously moderately to severely active UC:

  • The American College of Gastroenterology recommends against systemic corticosteroids for maintenance of remission (moderate quality).
  • The continuation of anti-TNF therapy using adalimumab, golimumab, or infliximab is recommended to maintain remission after anti-TNF induction (moderate quality).
  • Continuing vedolizumab to maintain remission after induction with vedolizumab is recommended (moderate quality).
  • Continuing tofacitinib to maintain remission after induction with tofacitinib is recommended (moderate quality).

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Management of the Hospitalized Patient With Acute Severe UC:

  • Patients with acute severe UC should be tested for Clostridioides difficile infection (moderate quality).
  • Patients with acute severe UC who do not respond well to intravenous corticosteroids by 3 to 5 days should undergo medical rescue therapy with infliximab or cyclosporine (moderate quality).
  • Those who achieve remission with infliximab treatment should use the same agent to maintain remission (moderate quality).

“The appropriate management of patients with UC involves successful induction of both clinical and endoscopic remission, followed by the use of a steroid-free maintenance strategy,” noted the authors of the guidelines. “Choice of therapy for UC is based on activity, severity, extent of inflammation, and prognostic factors and may include oral, topical (rectal), or systemic therapies, as well as surgery. When possible and appropriate based on individual clinical factors, organ-specific treatments can be used before systemic therapies.”


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Reference

Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114:384-413.

This article originally appeared on Clinical Advisor