The American Gastroenterological Association has updated guidance for the treatment of ulcerative colitis to recommend using higher efficacy drugs in earlier stages of treatment, Medscape Medical News reported Nov. 25.
Here are eight things to know about the updated guidelines:
1. "These are the first living guidelines published by a GI society, highlighting the interest and need to provide timely guidance to all stakeholders in a rapidly evolving field," researcher Siddharth Singh, MD, a gastroenterologist of University of California San Diego, in La Jolla, told Medscape.
2. The recommendations suggest more advanced therapies, like biologics and small-molecule drugs, should be used earlier on in the treatment process than was previously recommended.
3. A patient-centered document was included with the recommendations, which clarified that the guidelines are "meant to be broad recommendations for management of patients with moderate to severe UC and are not intended to address the intricacies of individual patients."
4. The guidance comes after numerous developments in medications for ulcerative colitis, according to the report.
"The choice of medications for moderate to severely active UC has expanded tremendously in the past few years," James Lewis, MD, a professor of medicine and epidemiology at the University of Pennsylvania in Philadelphia, told Medscape. "This resulted in the dismantling of the historical therapeutic pyramid."
5. The guidance recommends advanced or immunomodulatory therapy after failure of 5-aminosalicylates instead of a "step-up" approach. The recommendations also define moderate to severe disease using a Mayo endoscopic severity subscore of 2or 3.
6. The AGA published a full list of specific medications and the updated recommendations for their use in Gastroenterology.
7. Dr. Lewis also said that the guidance will be useful for both highly specialized gastroenterologists and community physicians, but that not all patients and providers may have the same priorities as the guidelines.
"There are a few nuances to the methods of the AGA guidelines. For example, the panel prioritized efficacy over safety because the incidence of serious adverse events secondary to medications is relatively rare," he said.
8. The researchers also identified several gaps in knowledge that future studies should address, including a lack of head-to-head comparison trials that include active comparators. They also noted a literature gap on the efficacy of different therapies after failure of or intolerance to non-tumor necrosis factor antagonist advanced therapy.