From the Guidelines
The first-line treatment for Ulcerative Colitis (UC) in adolescents is oral and rectal 5-aminosalicylate (5-ASA) therapy.
Treatment Overview
- For mild to moderate UC, 5-ASA is recommended as first-line therapy to induce symptomatic remission, with a dosage of 1 g daily for rectal 5-ASA and at least 1 g daily for 5-ASA enemas 1.
- The goal of therapy is complete remission, defined as both symptomatic and endoscopic remission without corticosteroid therapy 1.
- Corticosteroids are recommended as second-line therapy for patients who fail to respond to 5-ASA therapy, with a commonly used regimen of oral prednisone 40 to 60 mg/day (or equivalent) 1.
Key Considerations
- 5-ASA has been shown to be effective in inducing symptomatic and endoscopic remission in patients with mild to moderate active UC, with a pooled odds ratio for symptomatic remission of 8.30 and for endoscopic remission of 5.31 1.
- Corticosteroids have been shown to be superior to placebo for induction of remission, with a relative risk of no remission of 0.65 1.
- The optimal dose and dosing regimen for systemic corticosteroids in UC is uncertain, but oral prednisone 40 to 60 mg/day is a commonly used regimen 1.
From the Research
First-Line Treatment for Ulcerative Colitis (UC) in Adolescents
- The first-line treatment for adolescents with UC includes salicylates, such as mesalazine or sulphasalazine 2.
- According to a study published in 2012, oral 5-aminosalicylates (5-ASAs) are recommended as first-line therapy in patients with mild to moderate UC 3.
- Another study published in 2016 states that mesalamine is the first-line treatment in patients with mild to moderate UC 4.
- Corticosteroids, such as prednisolone, may also be used as first-line treatment, but their use is often limited due to potential adverse effects on growth and development in children and adolescents 2, 5.
- More recently, subcutaneous anti-TNF medication, such as adalimumab, has been considered as an alternative first-line therapy for pediatric UC 6.
Treatment Options
- Mesalazine or sulphasalazine are commonly used as first-line medications for UC in adolescents 2.
- Corticosteroids, such as prednisolone, may be used in combination with other medications or as an alternative to first-line medications 2, 5.
- Anti-TNF drugs, such as infliximab, adalimumab, and golimumab, may be used for more severe or refractory cases of UC 4.
- Vedolizumab, a drug directed against the integrins α4β7, has been shown to be effective for the induction and maintenance of remission in moderate-to-severe UC patients 4.