From the Guidelines
For treating a left-sided ulcerative colitis flare, start with topical mesalamine therapy using 4g mesalamine enemas daily for 2-4 weeks, combined with oral mesalamine at 2.4-4.8g daily, as this approach is more effective than oral or topical aminosalicylates, or topical steroids alone 1.
Treatment Approach
When managing left-sided ulcerative colitis, it's crucial to consider the severity of the flare and the patient's response to initial treatment.
- For mild to moderate flares, the combination of topical and oral mesalamine is recommended, with oral beclomethasone dipropionate being a non-inferior alternative to prednisone for some patients 1.
- If symptoms do not improve within 2 weeks, adding oral prednisone at 40mg daily, tapering by 5mg weekly over 8 weeks, is a reasonable next step, especially for moderate-to-severe flares 1.
Alternative and Additional Therapies
- Topical corticosteroids like budesonide MMX can be used as alternatives to mesalamine enemas, particularly for patients who cannot tolerate or do not respond to mesalamine 1.
- Oral budesonide MMX 9 mg daily has been shown to be significantly more effective than placebo in inducing remission in mild to moderate UC, especially in left-sided disease 1.
Monitoring and Adjustments
- Ensure adequate hydration and monitor for complications like anemia or electrolyte imbalances.
- If symptoms worsen or do not respond within 2 weeks of steroid therapy, seek prompt medical attention as biologics (like infliximab or vedolizumab) may be needed.
Quality of Life Considerations
Maintaining treatment until symptoms resolve completely is crucial to prevent early relapse and improve quality of life. The choice of treatment should also consider the potential side effects and the impact on the patient's daily life, with the goal of minimizing morbidity and mortality while maximizing quality of life.
From the FDA Drug Label
1.3 Ulcerative Colitis RENFLEXIS is indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy. 2.3 Ulcerative Colitis The recommended dose of RENFLEXIS is 5 mg/kg given as an intravenous induction regimen at 0,2 and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter for the treatment of adult patients with moderately to severely active ulcerative colitis.
Treatment Options for Left-Sided Ulcerative Colitis (UC) Flare:
- Infliximab (IV): 5 mg/kg given as an intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks. 2
From the Research
Treatment Options for Left-Sided Ulcerative Colitis (UC) Flare
- The treatment of left-sided UC flare typically involves the use of aminosalicylates, such as mesalamine, which have been shown to be effective in inducing and maintaining remission 3, 4, 5, 6, 7.
- Topical (rectal) formulations of aminosalicylates, such as suppositories or enemas, are often used to treat left-sided UC, as they allow for direct delivery of the medication to the affected area and can be more effective than oral formulations 4, 5, 7.
- Oral aminosalicylates, such as mesalamine, can also be used to treat left-sided UC, particularly in patients with more extensive disease or who are unable to tolerate topical formulations 3, 4, 6.
- The dosage of mesalamine can vary depending on the severity of the disease and the formulation used, with doses ranging from 1.5 g/day to 4.8 g/day 3, 6.
- In addition to aminosalicylates, topical steroids, such as budesonide, may also be used to treat left-sided UC, particularly in patients who do not respond to aminosalicylates 4, 7.
- Immunomodulators, such as azathioprine or 6-mercaptopurine, may be used in patients with frequent or severe relapses, while biologics, such as infliximab, may be considered in patients who do not respond to other treatments 4.