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

Journal

Intestinal Research

Year

2024

Materials & Methods

On October 27, 2023, 24 members of the Asia-Pacific, Middle East, and Africa (APMA) IBD Coalition convened in Taiwan to address critical issues and ongoing challenges in the management of moderate UC in the APMA region. The APMA IBD Coalition consists of 24 experts from countries/regions such as Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, the Philippines, Singapore, South Africa, Taiwan, Thailand, Turkey, and Vietnam. The panel discussed and provided insights on the following objectives: (1) to define and establish a clinically relevant and practical approach to risk stratifying and managing moderate UC; (2) to employ a proactive approach to treating moderate UC based on region-specific predictive factors; (3) to review the current moderate UC management strategies to minimize the burden on both patients and healthcare; (4) to optimize the utilization of conventional therapies through improved treatment intensification, dosage optimization, and treatment adherence before considering treatment escalation; and (5) to formulate cost-effective treatment strategies tailored to the APMA region. The discussions were followed by electronic live polling to quantify agreement on clinical approaches for moderate UC classification and treatment. The ensuing expert recommendations are presented herein and summarized in Table 1.

Conclusion

Moderate UC represents a distinct phenotype that necessitates clinical attention. Existing guidelines lack a consistent definition and comprehensive recommendations for moderate UC treatment, which may contribute to indiscriminate and premature escalation to advanced therapies, which may have adverse consequences for the patient. This article may guide the identification of patients with moderate UC and treatment by way of a simplified treatment algorithm, emphasizing the importance of timely and accurate risk stratification in order to devise appropriate treatment strategies. The Truelove and Witts criteria, along with other tools and biomarkers for measuring disease activity, can be used to identify patients who have moderate UC, in the absence of universally accepted criteria. 5-ASA remains a first-line treatment for patients with moderate UC. In patients with moderate UC who do not exhibit predictors of aggressive disease, 5-ASA treatment can be optimized through careful selection of an appropriate product formulation (e.g., prolonged-release formulations, granule form), the use of an effective optimized dose (4 g/day), and the implementation of a once-daily regimen, while educational and behavioral interventions may be utilized to enhance patient adherence. 5-ASA treatment should be maintained for as long as the patient responds to the treatment. Patients with inadequate response to the induction regimen despite optimization may benefit from add-on oral corticosteroids or budesonide MMX prior to escalation to immunomodulators or advanced therapies. It is hoped that addressing the unique challenges and complexities associated with moderate UC management will contribute to the development of tailored therapeutic strategies that align with individual patient needs and preferences, ultimately enhancing the delivery of high-quality care of patients with moderate UC in diverse real-world clinical settings.

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https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2024.00089

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