Journal List > Korean J Gastroenterol > v.71(4) > 1007752

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

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.

References

1. Braegger CP, Nicholls S, Murch SH, Stephens S, MacDonald TT. Tumour necrosis factor alpha in stool as a marker of intestinal inflammation. Lancet. 1992; 339:89–91.
2. Sandborn WJ, Targan SR. Biologic therapy of inflammatory bowel disease. Gastroenterology. 2002; 122:1592–1608.
3. Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011; 141:1194–1201.
4. Choi CH, Moon W, Kim YS, et al. Second Korean guidelines for the management of ulcerative colitis. Korean J Gastroenterol. 2017; 69:1–28.
5. Harbord M, Eliakim R, Bettenworth D, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017; 11:769–784.
6. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005; 353:2462–2476.
7. Choi CH, Kim YH, Kim YS, et al. Guidelines for the magnagement of ulcerative colitis. Korean J Gastroenterol. 2012; 59:118–140.
8. Reinisch W, Sandborn WJ, Hommes DW, et al. Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis: results of a randomised controlled trial. Gut. 2011; 60:780–787.
9. Sandborn WJ, van Assche G, Reinisch W, et al. Adalimumab induces and maintains clinical remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2012; 142:257–265. e1–3.
10. Sandborn WJ, Feagan BG, Marano C, et al. Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2014; 146:85–95. quiz e14–15.
11. Feagan BG, Rutgeerts P, Sands BE, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013; 369:699–710.
12. Magro F, Gionchetti P, Eliakim R, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017; 11:649–670.
13. Danese S, Fiorino G, Raine T, et al. ECCO position statement on the use of biosimilars for inflammatory bowel disease-an update. J Crohns Colitis. 2017; 11:26–34.
14. Sandborn WJ, Ghosh S, Panes J, et al. Tofacitinib, an oral Janus kinase inhibitor, in active ulcerative colitis. N Engl J Med. 2012; 367:616–624.
15. Sandborn WJ, Sands BE, Danese S, et al. Efficacy and safety of oral tofacitinib as maintenance therapy in patients with moderate to severe ulcerative colitis: results from a phase 3 randomized controlled trial. Gastroenterology. 2017; 152(5 Suppl 1):S199.
16. Sandborn WJ, Feagan BG, Wolf DC, et al. Ozanimod induction and maintenance treatment for ulcerative colitis. N Engl J Med. 2016; 374:1754–1762.
17. Vermeire S, O'Byrne S, Keir M, et al. Etrolizumab as induction therapy for ulcerative colitis: a randomised, controlled, phase 2 trial. Lancet. 2014; 384:309–318.

Table 1.
Comparison of Biologic Agent Use according to Guidelines4,5,13
  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.

TOOLS
Similar articles