From the Guidelines
Treatment of Acute Ulcerative Colitis Flare Induced by NSAIDs
Low-dose ecospere (budesonide) may be considered as an adjunctive treatment to induce remission in patients experiencing an acute ulcerative colitis flare induced by nonsteroidal anti-inflammatory drugs (NSAIDs) 1.
Adjunctive Treatment Options
- Budesonide: Low-dose budesonide (9mg daily) may be used as an adjunctive treatment to induce remission, with a treatment duration of typically 4-8 weeks, and a gradual tapering of the dose over 2-4 weeks once clinical remission is achieved 1.
- Mesalamine: Oral mesalamine (2.4-4.8g daily) may be initiated or optimized to manage the flare, with the addition of a low-dose corticosteroid such as prednisone (20-30mg daily) for a limited duration of 2-4 weeks 1.
- Beclomethasone Dipropionate: Beclomethasone dipropionate (5mg daily) may also be considered as an alternative adjunctive treatment to induce remission 1.
Clinical Guidelines
The British Society of Gastroenterology consensus guidelines recommend the use of oral 5-ASA (2–3 g/day) as the first-line treatment for mild to moderate ulcerative colitis, with the addition of oral corticosteroids such as prednisolone for patients who do not respond to 5-ASA therapy 1. The AGA clinical practice guidelines suggest using standard-dose oral mesalamine or diazo-bonded 5-ASA, rather than budesonide MMX or controlled ileal-release budesonide for induction of remission 1.
Treatment Approach
In patients with mild to moderate ulcerative colitis, a step-up approach may be used, starting with oral 5-ASA (2–3 g/day) and adding oral corticosteroids such as prednisolone if necessary 1. For patients with extensive or left-sided mild-moderate ulcerative colitis, the addition of rectal mesalamine to oral 5-ASA may be considered 1.
From the Research
Treatment of Ulcerative Colitis
- The use of low-dose ecospere (budesonide) for the treatment of ulcerative colitis has been studied in several trials 2, 3, 4.
- Budesonide-MMX® 9 mg daily has been shown to be effective for induction of remission in active ulcerative colitis, particularly in patients with left-sided colitis 2.
- A study comparing budesonide-MMX® with mesalamine found that mesalamine was superior to budesonide for achieving remission in active ulcerative colitis 4.
- Another study found that budesonide-MMX® 9 mg was significantly superior to placebo for inducing remission (combined clinical and endoscopic remission) at 8 weeks 3.
NSAID-Induced Ulcerative Colitis
- There is limited evidence on the specific treatment of NSAID-induced ulcerative colitis.
- However, the general treatment of ulcerative colitis with mesalamine and corticosteroids may also be applicable to NSAID-induced cases.
- Low-dose low-molecular-weight heparin has been shown to be effective as an adjuvant treatment in active ulcerative colitis, but its use in NSAID-induced cases is not well-studied 5.
Adjuvant Treatments
- Low-dose low-molecular-weight heparin may be an effective adjuvant treatment in active ulcerative colitis, potentially delaying or precluding the need for steroid treatment 5.
- The importance of adherence to mesalamine treatment has been highlighted, with high adherence being more important than the daily dose for maintaining remission in ulcerative colitis 6.