Wednesday, March 4, 2015

Clinical Practice Guidelines for the Medical Management of Non-Hospitalized Ulcerative Colitis: The Toronto Consensus - Gastroenterology

Background & Aims

The medical management of ulcerative
colitis (UC) has improved through the development of new therapies and
novel approaches that optimize existing drugs. Previous Canadian
consensus guidelines addressed the management of severe UC in the
hospitalized patient. We now present consensus guidelines for the
treatment of ambulatory patients with mild-to-severe active UC.


systematic literature search identified studies on the management of
UC. The quality of evidence and strength of recommendations were rated
according to the Grading of Recommendation Assessment, Development, and
Evaluation (GRADE) approach. Statements were developed through an
iterative online platform, then finalized and voted on by a working
group of specialists.


The participants concluded
that the goal of therapy is complete remission defined as both
symptomatic and endoscopic remission without corticosteroids. The
consensus includes 34 statements focused on five main drug classes,
5-aminosalicylate (ASA), corticosteroids, immunosuppressants, anti-tumor
necrosis factor-alpha (TNF) therapies, and other therapies. Oral and
rectal 5-ASAs are recommended first-line therapy for mild-to-moderate
UC, with corticosteroid therapy for those who fail to achieve remission.
Patients with moderate-to-severe UC, should undergo a course of oral
corticosteroids, with transition to 5-ASA, thiopurines, anti-TNF therapy
(with or without thiopurines or methotrexate), or vedolizumab
maintenance therapy in those who successfully achieve symptomatic
remission. For patients with corticosteroid-resistant/dependent UC,
anti-TNF therapies or vedolizumab are recommended. Timely assessments of
response and remission are critical to ensuring optimal outcomes.


management of UC requires careful patient assessment, evidence-based
use of existing therapies, and thorough assessment to define treatment

- Gastroenterology