Guideline Issued for Treatment of Mild/Moderate Ulcerative Colitis
Standard-dose mesalamine or diazo-bonded 5-ASA recommended versus low-dose mesalamine
TUESDAY, Jan. 15, 2019 (Pharmacist's Briefing) -- A new clinical guideline from the American Gastroenterological Association (AGA) published Dec. 18 in Gastroenterology focuses on the medical management of patients with mild-to-moderate ulcerative colitis (UC).
To inform the guideline, Siddharth Singh, M.D., from the University of California in San Diego, and colleagues compiled the clinical evidence in accordance with the Grading of Recommendations Assessment, Development, and Evaluation framework.
In the guideline, Cynthia W. Ko, M.D., from the University of Washington in Seattle, and colleagues note that most UC patients have a mild-to-moderate course characterized by periods of activity or remission. For patients with extensive mild-to-moderate UC, using standard-dose mesalamine or diazo-bonded 5-ASA is recommended rather than low-dose mesalamine, sulfasalazine, or no treatment. Rectal mesalamine should be added to oral 5-ASA for patients with extensive or left-sided mild-to-moderate UC. High-dose mesalamine with rectal mesalamine is recommended for patients with mild-to-moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA. Once-daily dosing is recommended rather than multiple-daily dosing for patients with mild-to-moderate UC being treated with oral mesalamine. For induction of remission, standard-dose oral mesalamine or diazo-bonded 5-ASA is recommended rather than budesonide MMX or controlled ileal-release budesonide.
"We identified several knowledge gaps and areas for future research in this patient population," Ko and colleagues write. "Due to evidence gaps, the AGA makes no recommendation for use of probiotics, curcumin, or fecal microbiota transplantation in patients with mild-to-moderate UC."
One author of the technical review disclosed financial ties to the pharmaceutical industry.