From the Guidelines
Prolonged or interval can indicate a period of time during which a patient's symptoms or disease activity are being monitored, and can be used to inform treatment decisions or adjustments. This approach is often used in the management of chronic conditions such as Crohn's disease or ulcerative colitis, where patients may experience periods of remission or flare-ups. For example, in patients with ulcerative colitis in symptomatic remission, the American Gastroenterological Association (AGA) suggests a monitoring strategy that combines biomarkers and symptoms, rather than relying on symptoms alone 1. In this context, interval symptom-based monitoring may be a reasonable choice for patients who place a high value on avoiding the burden of biomarker testing, over a potentially higher risk of flare or overtreatment. However, it is essential to consider the potential consequences of testing and associated costs, as well as the optimal management strategy in cases of discrepancy between symptoms and biomarkers 2. In general, a biomarker-based monitoring strategy, especially using stool-based tests, may be inconvenient and elevated biomarkers in otherwise asymptomatic individuals may lead to high patient anxiety. Therefore, it is crucial to weigh the benefits and risks of different monitoring strategies and to consider the individual patient's preferences and values when making treatment decisions. Ultimately, the goal of monitoring is to improve patient outcomes, reduce morbidity and mortality, and enhance quality of life, and the choice of monitoring strategy should be guided by the best available evidence and tailored to the individual patient's needs.
From the Research
Prolonged or Interval Indication
- Prolonged or interval indication can refer to the prolonged use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, which can lead to various adverse effects, including gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary complications.
- The QT interval, a measure of the time it takes for the heart's ventricles to prepare for a new beat, can be prolonged by certain medications, increasing the risk of torsades de pointes, a potentially life-threatening heart rhythm disorder 6.
- Interval indication can also refer to the timing and frequency of medication administration, such as the use of corticosteroids for joint pain, which can provide moderate short-term benefits but may have limited long-term effectiveness and potential adverse effects 7.
Medication-Related Effects
- NSAIDs can produce a range of beneficial effects, including analgesia, antipyretic, anti-inflammatory, and antithrombotic properties, but are also associated with significant side effects, such as delay in soft tissue and bone healing, renal and liver toxicity, and gastric irritation and ulceration 3, 4, 5.
- Corticosteroids can provide moderate short-term benefits for reducing pain and improving functioning in joint pain conditions, but may have limited long-term effectiveness and potential adverse effects, such as toxicity to articular cartilage and numerous systemic side effects 7.
Clinical Considerations
- Clinicians should be aware of the potential risks and benefits of medications that can prolong the QT interval and take steps to minimize the risk of torsades de pointes, such as monitoring the QT interval in patients receiving QT-prolonging medications 6.
- The use of NSAIDs and corticosteroids requires careful consideration of the risk-benefit threshold, taking into account the potential adverse effects and the individual patient's clinical variables 3, 4, 7, 5.