Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition.
Journal
Intestinal research
Journal Volume
23
Journal Issue
1
Start Page
37
End Page
55
ISSN
1598-9100
Date Issued
2025-01
Author(s)
Akyüz, Filiz
An, Yoon Kyo
Begun, Jakob
Aniwan, Satimai
Bui, Huu Hoang
Chan, Webber
Choi, Chang Hwan
Chopdat, Nazeer
Connor, Susan J
Desai, Devendra
Flanagan, Emma
Kobayashi, Taku
Lai, Allen Yu-Hung
Leong, Rupert W
Leow, Alex Hwong-Ruey
Leung, Wai Keung
Limsrivilai, Julajak
Muzellina, Virly Nanda
Peddi, Kiran
Ran, Zhihua
Sollano, Jose
Teo, Michelle Mui Hian
Wu, Kaichun
Ye, Byong Duk
Ooi, Choon Jin
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.
Subjects
5-Aminosalicylates
Inflammatory bowel diseases
Treatment optimization
Ulcerative colitis
Type
review article