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

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


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.


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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.

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