This protocol applies to patients with primary sclerosing cholangitis and concomitant inflammatory bowel disease whose first-line colitis treatment has failed to meet its primary therapeutic goal.
Primary sclerosing cholangitis occurring alongside inflammatory bowel disease (PSC-IBD) requires active treatment of the colitic component. Treatment in line with current practice guidelines, with the goal of achieving mucosal healing, is recommended for this population.
The prior treatment line employed 5-aminosalicylic acid for colitis — selected in part for its role in reducing the risk of colorectal cancer and dysplasia in PSC-IBD. Escalation to this protocol is indicated when mucosal healing has not been achieved on that regimen.
When mucosal healing is not reached on 5-aminosalicylic acid, biologic therapy becomes the next consideration. The full structured regimen — including which agent class applies in this setting and under what conditions — is available in the protocol below.
DOI: 10.1016/j.jhep.2022.05.011
Treatment of PSC-related IBD in line with current practice guidelines with the goal of achieving mucosal healing is recommended.
Treatment with biologics is often not indicated in patients with mild inflammation but they should be used if needed.
The effect of anti-TNF in IBD with concomitant PSC has been studied in small or retrospective studies where biologics have been used for the IBD indication.
View source ↗