Comparison of Treatment Guidelines for Ulcerative Colitis: Role of Biologics

Jung Ho Bae; Dong-Hoon Yang

doi:10.4166/kjg.2018.71.4.192

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Bae and Yang: Comparison of Treatment Guidelines for Ulcerative Colitis: Role of Biologics

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Korean J Gastroenterol 2018;71(4):192-195.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.4.192

Comparison of Treatment Guidelines for Ulcerative Colitis: Role of Biologics

Jung Ho Bae, Dong-Hoon Yang¹

Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea

¹Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Dong-Hoon Yang, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-5809, Fax: +82-2-3010-6517, E-mail: dhyang@amc.seoul.kr

Received 2 April 2018 Revised 10 April 2018 Accepted 11 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Ulcerative colitis (UC) is a chronic inflammatory condition of the colon, characterized by diffuse mucosal inflammation with bloody diarrhea. The therapeutic goals in UC have evolved from symptomatic relief to deep remission, including sustained steroid-free clinical remission, mucosal healing, and ideally histologic remission. The management of UC has significantly been improved by advance of biologic agents including anti-tumor necrosis factor alpha (TNF-α) antibodies. Anti-TNF-α agent have progressively been introduced earlier in treatment algorithms for UC in order to minimize steroid exposure and dependence and to maximize disease control and quality of life. We reviewed the therapeutic recommendations of biologic agents for UC in the Korean and European Crohn's and Colitis Organization guidelines.

Keywords: Ulcerative colitis, Tumor necrosis factor-alpha, Biological products

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Table 1.

Comparison of Biologic Agent Use according to Guidelines^4,5,13

	2017 KASID guideline	2017 ECCO guideline
Indication	Lack of efficacy/contraindication/intolerance of classical treatment using steroid or immunomodulators	Same as left
	Steroid defendant disease
First choice of biologics	Anti-TNFs (infliximab, adalimumab, and golimumab)	Anti-TNFs or anti-integrin agent (vedolizumab)
Primary nonresponse	Vedolizumab may be more effective than switching to another anti-TNF	Change to different anti-TNFs or alternative class of agent (e.g. vedolizumab)
Secondary loss of response	Change to different anti-TNFs or vedolizumab according to therapeutic drug monitoring	Same as left
Combining anti-TNF and immunomodulators	Combining anti-TNF and immunomodulators is recommended for immunomodulator-naïve patients	Same as left
Duration of treatment with biologics	Prolonged use of biologics may be needed until loss of response	Same as left
Switching from originator to a biosimilar	Not mentioned	Accepted after informed consent and shared decision making with patients

KASID, Korean Association for the Study of Intestinal Diseases; ECCO, European Crohn's and Colitis Organization; TNF, tumor necrosis factor.

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