IBD Treatmet Plan of UC

IBD Treatmet Plan
of UC

Mild-Moderate

Indution Therapy

Mild-Moderate

Topical CS:
limited role. reserved for patients who are intolerant or
unresponsive to topical mesalamine.
The oral budesonide MMX formulation, only for pt unresponsive to optimized topical.
Oral prednisone is also an option; however, its
effects are systemic.
Patients requiring systemic corticosteroids should have them tapered over 4 to 12 weeks

Moderate-Severe

Oral budesonide MMX (4 mod-sev active extensive UC.
prednisone 40 to 60 mg/day (4 weeks) recommended for any extent

Biological Agents (Cornerstone)
Choice depends on depends on previous exposure to biologic agents.
Naive pts. infliximab or vedolizumab + immunomodulator (eg, azathioprine) is recommended.
For pt previously Tx with biological, give ustekinumab or tofacitinib

ASUC

Acute severe UC: (ASUC) , Hospitalization required, methylprednisolone 40 to 60 mg IV per day. IF no respond after 3-4 days, give infliximab or cyclosporin continuous IV infusion of 2–4 mg/kg/day.

Topical mesalamine is superior to both topical corticosteroids and oral aminosalicylates in patients with distal disease.
Enemas are appropriate for patients with left-sided disease because the medication will reach the splenic flexure.
Suppositories suitablr for proctitis.
Combination of oral and topical mesalamine preparations is more effective.
Combination is more effective in extensive or left-sided disease.
DOSE: oral mesalamine dose target dose should be 2 to 3 g/day (3 g only if no response).
Induction of

DOSE: oral mesalamine dose target dose should be 2 to 3 g/day (3 g only if no response).
Induction of

Maintenance of
Remission in UC

Mildly active proctitis,

mesalamine enemas for left-sided disease often dosed 2 to 3 times weekly

Oral mesalamine at doses of at least 2 g/day +- Topical therapy

mesalamine suppositories 1 g daily

Moderately - severely OR pt.
with Cs dependency:

Budesonide oral MMX may be continued for up
to 8 weeks; systemic CS should be tapered over 4 to 12 weeks

mesalamine NOT effective in this case

-Immunomodulators (eg, azathioprine, 6-MP)

TNF agents (eg, infliximab, adalimumab, golimumab)
vedolizumab, ustekinumab, or tofacitnib
Combining a thiopurine and anti-TNF agent is more effective

ASCU

If remession achieved with infliximab, continue.
If remession achieved cyclosporin, azathioprine or vedolizumab

Progressive disease who cannot be maintained on
drug therapy alone, Colectomy