This protocol applies to patients with mildly to moderately active left-sided ulcerative colitis who have undergone a prior induction attempt with oral budesonide MMX and have not achieved the expected remission targets.

Previous treatment — target not reached

The prior protocol used oral budesonide MMX to induce remission. This next-line protocol is indicated when that treatment failed to achieve the defined goals: absence of rectal bleeding and a Mayo endoscopic score of 0 or 1.

Next-step approach (partial overview)

When oral budesonide MMX has not achieved remission, this protocol moves to oral systemic corticosteroids for remission induction. The complete regimen, clinical decision points, and sequencing are available in the full protocol.

Clinical response targets

Clinical response is expected within 5–7 days, with decreasing rectal bleeding and decreasing stool frequency as the key early indicators of treatment success.

References

DOI: 10.14309/ajg.0000000000003463

In patients with mildly to moderately active left-sided UC, we suggest rectal 5-ASA enemas at a dose of at least 1 g/daily combined with oral 5-ASA at a dose of at least 2.0 g/daily compared with oral 5-ASA therapy alone for induction of remission
In patients with UC of any extent who fail to respond to 5-ASA therapy, we recommend oral systemic corticosteroids to induce remission
The typical starting doses of oral prednisone are 40–60 mg daily, usually in a single dose, and clinical response is expected within 5–7 days of treatment.

View source ↗

Mildly to Moderately Active Left-Sided Ulcerative Colitis When Oral Budesonide MMX Has Not Induced Remission

References