Mildly to Moderately Active Extensive Ulcerative Colitis Not Responding to Oral 5-ASA
This protocol covers the specific situation of mildly to moderately active extensive ulcerative colitis where initial first-line therapy has failed to achieve remission, and a next treatment step is required.
When the Previous Treatment Did Not Work
The established first approach for this presentation is oral 5-ASA to induce remission. When the response is reassessed within 8 weeks and the patient has not achieved absence of rectal bleeding, resolution of bowel urgency, normalised stool frequency, and a Mayo endoscopic score of 0 or 1 — escalation to this next-line protocol is indicated.
Next-Line Approach
When oral 5-ASA alone has not achieved remission, the protocol involves adding a targeted oral corticosteroid preparation to the ongoing 5-ASA regimen. The complete structured approach, including agent selection and management details, is available in the full protocol.
Remission Targets
Success is defined as absence of rectal bleeding and a Mayo endoscopic score of 0 or 1.
References
DOI: 10.14309/ajg.0000000000003463
- In patients with mildly to moderately active extensive colitis, oral 5-ASA at a dose of at least 2.0 g daily is recommended to induce remission
- In patients with mildly to moderately active UC of any extent not responding to oral 5-ASA, we recommend the addition of budesonide MMX 9 mg/d to induce remission
- In clinical trials, the definition of clinical remission has been a MES of 0 or 1, stool frequency of ≤1, and absence of rectal bleeding.