Abstract
Mesalamine (5-ASA) is the mainstay therapy in patients with mild-to-moderate active ulcerative colitis (UC). However, non-adherence to therapy and practice variability among gastroenterologists represent long-standing barriers, leading to poor outcomes. Additionally, targets to treat in UC are increasingly evolving from focusing on clinical remission to achieving endoscopic and histological healing. To date, systemic steroids are still recommended in non-responders to 5-ASA, despite their well-known side effects. Importantly, with the advent of new therapeutic options such as oral corticosteroids with topical activity (e.g., budesonide multimatrix system (MMX)), biologics, and small molecules, some issues need to be addressed for the optimal management of these patients in daily clinical practice. The specific positioning of these drugs in patients with mild-to-moderate disease remains unclear. This review aims to identify current challenges in clinical practice and to provide physicians with key strategies to optimize treatment of patients with mild-to-moderate UC, and ultimately achieve more ambitious therapeutic goals.
Highlights
Ulcerative colitis (UC) is a chronic, immune-mediated inflammatory bowel disease (IBD), characterized by recurrent flares and periods of remission [1]
2 g once daily is associated with better remission rates Combined with 5-aminosalicylic acid (5-ASA) enema, prolonged-release 5-ASA OD 4 g is as effective as 2 g twice daily for inducing remission
OD dosing of delayed-release 5-ASA is as effective as bis in die (BD) dosing for maintenance of clinical remission
Summary
Ulcerative colitis (UC) is a chronic, immune-mediated inflammatory bowel disease (IBD), characterized by recurrent flares and periods of remission [1]. Current guidelines recommend oral and/or topical 5-aminosalicylic acid (5-ASA; mesalamine) as first-line medication for induction and maintenance therapy in mild-to-moderate UC, reserving oral systemic steroids for patients who are either intolerant or not adequately controlled with 5-ASA [11]. Despite their effectiveness in inducing remission, the use of oral corticosteroids is limited by their well-known adverse effects (AEs) [12]. The purpose of this review is to identify drawbacks and challenges in the management of mild-to-moderate UC, with the aim of providing key effective strategies to support physicians in daily practice in the 2020 clinical scenario
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