From the Guidelines
Tremfya should not be used for ulcerative proctitis due to lack of approval and sufficient evidence for this indication. The current standard treatments for ulcerative proctitis include mesalamine suppositories, which are probably more effective than placebo for induction of remission (moderate quality evidence) and maintenance of remission (low quality evidence), as stated in the AGA technical review on the management of mild-to-moderate ulcerative colitis 1. Some key points to consider for the treatment of ulcerative proctitis include:
- Mesalamine suppositories are a first-line treatment option
- Corticosteroid suppositories may be beneficial for induction of remission, although the evidence is indirect and of low quality
- Other treatment options, such as oral mesalamine, systemic corticosteroids, immunomodulators, or biologics like anti-TNF agents, vedolizumab, or ustekinumab, may be used for more severe or refractory cases. Tremfya, an IL-23 inhibitor, is FDA-approved for plaque psoriasis and psoriatic arthritis, but not for inflammatory bowel diseases like ulcerative proctitis, and therefore should not be used as a treatment option for this condition. Treatment should be prescribed by a gastroenterologist who can determine the most appropriate therapy based on disease severity, extent, and individual patient factors.
From the Research
Treatment Options for Ulcerative Proctitis
- The current treatment options for ulcerative proctitis include topically administered 5-aminosalicylates (5-ASA) and corticosteroids, which are effective in inducing remission 2, 3, 4, 5.
- The combination of topical and oral 5-ASA and steroids should be considered for escalation of treatment 2, 4.
- Refractory patients may require immunomodulators or biological therapy 2, 4.
Use of Guselkumab (Tremfya) for Ulcerative Proctitis
- There is limited information available on the use of guselkumab (Tremfya) for ulcerative proctitis specifically 6.
- Guselkumab has been approved for the treatment of moderately to severely active ulcerative colitis, and has shown efficacy in inducing clinical remission and improving symptoms 6.
- However, its use for ulcerative proctitis has not been extensively studied, and more research is needed to determine its effectiveness for this specific condition.
Current Research and Recommendations
- The current research suggests that topical 5-ASA is superior to placebo for the induction and maintenance of clinical remission in patients with ulcerative proctitis 5.
- The role of biological therapies, such as guselkumab, in the treatment of ulcerative proctitis is still being studied, and more research is needed to determine their effectiveness 6.