Chronic active ulcerative colitis is associated with significant morbidity, loss of productivity, increased colorectal cancer risk and cost.
Up to 18% of patients suffer chronic active disease, with 30% requiring colectomy at 10 years.
Dr Mehta and colleagues from the United Kingdom reported that the management remains challenging given the relatively few clinical trials in this area.
The researchers summarized the evidence regarding optimal management strategies for patients with chronic active ulcerative colitis of differing disease extents and degrees of treatment refractoriness.
The team searched the literature using the PubMed and Medline databases.
No time limit was set on article publication for inclusion.
|Infliximab and topical tacrolimus are options in refractory proctitis|
|Alimentary Pharmacology & Therapeutics|
The team of doctors reported that the principles of management should focus on confirming disease activity, exclusion of alternative diagnoses, adherence and treatment escalation.
Infliximab and topical tacrolimus are options in refractory proctitis, although the evidence for these therapies is limited.
The doctors examined that both infliximab and adalimumab are effective in corticosteroid-refractory disease, although the proportions of patients achieving corticosteroid-free remission remain modest.
Alternatives include ciclosporin and tacrolimus, and possibly methotrexate.
Colectomy often leads to an improved quality of life, and medical strategies unlikely to provide durable corticosteroid-free remission should not be pursued.
Dr Metha's team commented, "No current pharmacological treatment delivers mucosal healing in the majority of patients."
"Newer treatments such as vedolizumab and tofacitinib may represent valuable future therapies."
"Available medical options should be discussed with patients at every step of their management, with an honest appraisal of the evidence."
"Surgery should always be considered in patients with chronic refractory disease of any extent."