Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Intestinal Research Pub Date : 2024-11-04 DOI:10.5217/ir.2024.00089
Filiz Akyüz, Yoon Kyo An, Jakob Begun, Satimai Aniwan, Huu Hoang Bui, Webber Chan, Chang Hwan Choi, Nazeer Chopdat, Susan J Connor, Devendra Desai, Emma Flanagan, Taku Kobayashi, Allen Yu-Hung Lai, Rupert W Leong, Alex Hwong-Ruey Leow, Wai Keung Leung, Julajak Limsrivilai, Virly Nanda Muzellina, Kiran Peddi, Zhihua Ran, Shu Chen Wei, Jose Sollano, Michelle Mui Hian Teo, Kaichun Wu, Byong Duk Ye, Choon Jin Ooi
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Abstract

The lack of clear definition and classification for "moderate ulcerative colitis (UC)" creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

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优化 5-氨基水杨酸盐治疗中度溃疡性结肠炎:亚太、中东和非洲炎症性肠病联盟专家建议。
由于 "中度溃疡性结肠炎(UC)"缺乏明确的定义和分类,导致阶梯式治疗与自上而下治疗方法的适用性模糊不清。在本文中,专家们探讨了在评估和管理中度溃疡性结肠炎方面存在的关键差距。亚太、中东和非洲炎症性肠病联盟由 24 位专家组成,他们就中度 UC 的管理建议进行了交流、讨论和电子投票。专家们强调,治疗 UC 的目标是采用具有成本效益的策略,如 5- 氨基水杨酸盐 (5-ASA),达到临床、生物标志物和内镜缓解,这种疗法耐受性良好,可以优化治疗以改善疗效。专家们一致认为,5-ASA疗法可以通过最大限度地增加剂量(诱导缓解时每天4克)、结合口服和局部用药、将疗程延长至8周以上,以及通过个性化咨询和减少药片负担来提高患者的依从性等方式进行优化。理想情况下,应将治疗升级保留给具有侵袭性疾病预兆或对 5-ASA 优化治疗无效的患者。过早将治疗升级到高级疗法(包括生物制剂和口服小分子药物)可能会对健康和经济造成长期影响。本文提供了基于共识的专家建议以及基于当前证据和实践的治疗算法,以协助实际环境中的决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Intestinal Research
Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
7.40
自引率
10.20%
发文量
69
审稿时长
38 weeks
期刊介绍: Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.
期刊最新文献
Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition. Patient preferences for advanced therapies in ulcerative colitis using conjoint analysis. The evolving understanding of histology as an endpoint in ulcerative colitis. Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy. Efficacy of serum leucine-rich alpha-2 glycoprotein in predicting findings of Crohn's disease small bowel lesion in capsule endoscopy.
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