Management and treatment optimization of patients with mild to moderate ulcerative colitis

ABSTRACT

Introduction

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with a significant health-care burden worldwide. While medical therapy aims to induce and maintain remission, optimal management of mild to moderate UC remains challenging due to heterogeneity in severity classifications and non-standardized approaches. This comprehensive review summarizes current evidence and knowledge gaps to optimize clinical decision-making in patients with mild to moderate UC.

Areas covered

After an extensive literature search of PubMed, Medline, and Embase through August 2023, we provide an overview of definitions utilized to characterize mild to moderate UC severity and established therapeutic targets. Current medical treatments including mesalazine formulations, corticosteroids, and their combinations are surveyed. The role of emerging intestinal ultrasound, telemedicine, and home testing is explored. Individualized, patient-centered paradigms aiming to streamline care delivery through proactive identification of relapses are also examined.

Expert opinion

Addressing inconsistencies in disease activity stratification will better align tailored regimens with each patient’s profile. Advancing noninvasive technologies like ultrasound criteria and home testing could improve UC management by enabling personalized models. Realizing individualized plans through informed shared-decision making between health-care providers and fully engaged patients holds promise to maximize quality of life outcomes. Continuous improvement relies on innovation bridging different domains to overcome current limitations and push the field toward more predictive and tailored care.

KEYWORDS:

• 5-ASA
• budesonide MMX
• ulcerative colitis
• inflammatory bowel disease
• optimization
• quality of life
• biomarkers
• home testing

Article highlights

• The lack of a widely accepted definition for mild to moderate ulcerative colitis (UC) leads to study heterogeneity preventing standardization, proper stratification of patients and sub-optimal treatment and disease control.

• Mesalazine remains the mainstay therapy for mild to moderate UC, however optimizing formulations and combination strategies may further improve clinical outcomes.

• Individualized patient-directed management plans may significantly reduce flares and healthcare visits and improving patient’s quality of life compared to standard care.

• Telemedicine and home-based testing enable remote monitoring and individualized management in mild to moderate UC, improving efficiency and access, but require further validation.

• Intestinal ultrasound plays a central role in the management of mild to moderate UC thanks to its repeatability, low-cost, reliability and accuracy.

Declarations of interest

F D’Amico has served as a speaker for Sandoz, Janssen, Galapagos, and Omega Pharma; he also served as consultant for Ferring and as advisory board member for Galapagos, Abbvie and Nestlè. V Jairath has received consulting/advisory board fees from AbbVie, Alimentiv Inc, Arena pharmaceuticals, Asahi Kasei Pharma, Asieris, AstraZeneca, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Metacrine, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Prometheus, Reistone Biopharma, Roche, Sandoz, SecondGenome, Sorriso pharmaceuticals, Takeda, Teva, Topivert, Ventyx, Vividion; speaker’s fees from Abbvie, Ferring, Bristol Myers Squibb,Galapagos, Janssen, Pfizer, Shire, Takeda, Fresenius Kabi. K Paridaens is employee of Ferring Pharmaceuticals.S Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor. L Peyrin-Biroulet declares personal fees from Galapagos, AbbVie, Janssen, Genentech, Ferring, Tillots, Celltrion, Takeda, Pfizer, Index Pharmaceuticals, Sandoz, Celgene, Biogen, Samsung Bioepis, Inotrem, Allergan, MSD, Roche, Arena, Gilead, Amgen, BMS, Vifor, Norgine, Mylan, Lilly, Fresenius Kabi, OSE Immunotherapeutics, Enthera, Theravance, Pandion Therapeutics, Gossamer Bio, Viatris, Thermo Fisher; grants from Abbvie, MSD, Takeda, Fresenius Kabi; stock options from CTMA. The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Data availability statement

No new data were generated or analyzed in support of this research.

Author contribution

F D’Amico and S Danese conceptualized the manuscript. E Fasulo and F D’Amico contributed to the writing of the manuscript and the preparation of figures and tables. V Jairath, K Paridaens, S Danese and L Peyrin-Biroulet complemented and critically revised the contents. All authors have read and approved the final version of the manuscript for publication.

Additional information

Funding

This paper was funded by Ferring.