Emanuel Burri1, Michel H Maillard2, Alain M Schoepfer3, Frank Seibold4, Gert Van Assche5, Pauline Rivière6, David Laharie6, Michael Manz7. 1. Department of Gastroenterology and Hepatology, Cantonal Hospital Baselland, Liestal, Switzerland, emanuel.burri@ksbl.ch. 2. Crohn and Colitis Center, Gastroentérologie Beaulieu SA, Lausanne, Switzerland. 3. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. 4. Crohn-Colitis Zentrum, Hochhaus Lindenhofspital, Bern, Switzerland. 5. Department of Gastroenterology, University of Leuven and University Hospitals Leuven, Leuven, Belgium. 6. Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France. 7. Department of Gastroenterology and Hepatology, Clarunis, Basel, Switzerland.
Abstract
BACKGROUND: Patient care in ulcerative colitis (UC) remains challenging despite an array of established treatment options and emerging new therapies. The management of UC therapy should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome. Complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy, is the desired treatment goal. SUMMARY: This review focuses on treatment recommendations for different clinical scenarios in moderate-to-severe UC: Active UC of any extent not responding to aminosalicylates, steroid-dependent UC, steroid-refractory UC, immunomodulator-refractory UC, and acute severe UC. Comprehensive treatment algorithms for daily clinical practice were developed based on published guidelines and current literature. Key Messages: While current treatment options including a number of biologicals and small molecules have evolved UC treatment to achieve sustained remission in a majority of patients, upcoming treatment options with different molecular pathways and different modes of actions will further increase the need for personalized medicine.
BACKGROUND:Patient care in ulcerative colitis (UC) remains challenging despite an array of established treatment options and emerging new therapies. The management of UC therapy should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome. Complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy, is the desired treatment goal. SUMMARY: This review focuses on treatment recommendations for different clinical scenarios in moderate-to-severe UC: Active UC of any extent not responding to aminosalicylates, steroid-dependent UC, steroid-refractory UC, immunomodulator-refractory UC, and acute severe UC. Comprehensive treatment algorithms for daily clinical practice were developed based on published guidelines and current literature. Key Messages: While current treatment options including a number of biologicals and small molecules have evolved UC treatment to achieve sustained remission in a majority of patients, upcoming treatment options with different molecular pathways and different modes of actions will further increase the need for personalized medicine.