From the Guidelines
I strongly recommend that your grandmother with ulcerative colitis be treated with infliximab or vedolizumab as first-line therapy, as these biologics have shown high efficacy in inducing and maintaining remission, according to the most recent guidelines 1. The goal of treatment is to achieve and maintain remission, reduce inflammation, and improve quality of life by controlling symptoms like diarrhea, rectal bleeding, and abdominal pain.
- Treatment typically involves anti-inflammatory medications, but for moderate to severe cases, biologics such as infliximab (5mg/kg IV at weeks 0,2, and 6, then every 8 weeks) or vedolizumab may be necessary for induction and maintenance of remission 1.
- Immunomodulators like azathioprine (1.5-2.5mg/kg/day) may be considered for maintenance of remission, but thiopurine monotherapy should not be used for induction of remission, and methotrexate monotherapy should not be used for induction or maintenance of remission 1.
- Your grandmother should maintain a low-residue diet during flares, avoiding high-fiber foods, dairy, and spicy items that can irritate the colon, and stay well-hydrated, considering taking a multivitamin since nutrient absorption may be compromised.
- Regular monitoring through colonoscopies is important as ulcerative colitis increases colorectal cancer risk, and stress management techniques can help prevent flares, as emotional stress often triggers symptoms.
- The choice of treatment should be individualized, taking into account patient factors such as age, comorbidities, and preferences, and the use of JAK inhibitors, such as tofacitinib, should be cautious in patients at risk for adverse cardiovascular outcomes, including age 65 years or older, current or previous long-term smokers, a history of cardiovascular disease, and a history of cancer 1.
From the FDA Drug Label
To treat moderate to severe ulcerative colitis (UC) in adults and children 5 years of age and older. The FDA drug label indicates that adalimumab (HUMIRA) is used to treat moderate to severe ulcerative colitis (UC) in adults and children 5 years of age and older 2.
- Key points:
- HUMIRA is used for the treatment of UC.
- It is approved for use in adults and children 5 years of age and older.
- The safety and effectiveness of HUMIRA have been established for the treatment of moderately to severely active ulcerative colitis in pediatric patients 5 years of age and older 2.
From the Research
Treatment Options for Ulcerative Colitis
- Mesalamine is considered a first-line therapy for ulcerative colitis, with doses of more than 2.4 g/d achieving significantly higher rates of clinical and endoscopic remission, with a decreased risk of relapse 3.
- Mesalamine has few serious adverse effects and is generally well tolerated by patients, making it a safe option for long-term maintenance 4.
- For patients who are refractory to mesalamine or have more severe disease, steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab may be used to induce and/or maintain remission 5.
Importance of Adherence
- Adherence to mesalamine therapy is crucial, as nonadherence is common and can lead to decreased efficacy 3.
- Studies have shown that high adherence to mesalamine therapy can reduce the risk of flares, regardless of the daily dose 6.
- However, for patients with low adherence, a higher daily dose of mesalamine may be more effective in reducing the risk of flares 6.
Role of Corticosteroids
- Corticosteroids still play a crucial role in the management of active ulcerative colitis, particularly in patients with severe disease or those who do not respond to mesalamine therapy 7.
- Corticosteroids can be effective in inducing remission in mild to moderate flares, but are not recommended for long-term maintenance due to their association with multiple adverse effects 7.