Algorithms to facilitate shared decision-making for the management of mild-to-moderate ulcerative colitis

ABSTRACT

Introduction: Nonadherence has been a key barrier to the efficacy of medical treatments in ulcerative colitis (UC). Engaging patients in their IBD care via shared decision-making (SDM) to facilitate self-management may improve adherence to therapy.

Areas covered: This review aims to summarize the most recent trial evidence from 2012 to 2017 for mild-to-moderate UC in order to develop clinical algorithms that guide SDM to facilitate self-management. A structured literature search via multiple electronic databases was performed using the search terms ‘ulcerative colitis,’ ‘treatment,’ ‘management,’ ‘medication,’ ‘maintenance,’ ‘remission,’ ‘5-ASA,’ and ‘inflammatory bowel disease.

Expert commentary: Novel formulations of existing oral and topical medications have expanded the treatment options available for the induction and maintenance therapy for mild-to-moderate UC. Daily dosing of 5-ASA therapy is equivalent to twice daily dosing. The combination therapies of oral plus topical 5-ASA therapy and 5-ASA plus corticosteroid therapy are more effective than monotherapy. Budesonide MMX now plays a role in the management of mild-to-moderate UC. This review collates the evidence on drug efficacy and safety, adherence and tolerability, and noninvasive monitoring of mild-to-moderate UC into SDM-orientated algorithms to facilitate self-management.

KEYWORDS:

• Inflammatory bowel disease
• management
• ulcerative colitis
• corticosteroids
• distance management

Declaration of interest

B. Jackson has received educational support from Ferring and MSD. B. Jackson is supported by the National Health and Medical Research Council and By and Avant Doctor in Training Scholarship. P. De Cruz has received educational support and has been a paid speaker for Janssen, Celgene, Takeda, Ferring, Shire, Baxter. P. De Cruz is currently serving on advisory boards for Janssen, Celgene, Takeda, Ferring, Shire, Baxter. P. De Cruz has previously been supported by a GESA Bushel Postdoctoral Fellowship and David Bickart Clinician Research Fellowship from the University of Melbourne and is currently supported by a National Medical Health & Research Council Early career Fellowship. P. De Cruz has received unrestricted educational grant support from the Gutsy Group and Ferring.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.