check-up .’ Even among those without this co-morbidity but with chronic and active disease that has been present for 8 – 10 years , colonoscopy is still warranted but performed only every 3 – 5 years .
Q What are the treatments for patients with mild to moderate disease ?
A Amino-salicylates are the preferred first-line treatment option in milder disease and which are used with an initial high dose of 4 g / day for induction ( which can last 6 to 8 weeks ) and then reduced during maintenance therapy . This strategy he finds , seems to be more effective than using the regime intermittently . As Dr Panés explained . ‘ If patients do not continue with treatment , there is a 40 % risk of a disease flare the following year , which reduces to around 20 % if they maintain treatment .’ He added that an amino-salicylate regime is both very effective and well tolerated by patients and advises patients to ‘ maintain the treatment long-term because it has been associated with a reduced risk of cancer .’ Second-line treatments for those who still experience symptoms would be oral corticosteroids which again are initially given at a higher dose and slowly tapered off before returning the patient to amino-salicylates .
Treatment adherence for long-term conditions invariably reduces over time and as Dr Panés noted , ‘ there may be a temptation for patients who have been in remission for a long time to test what happens if they stop treatment .’ Although treatments can be stopped , he stressed the need for patients to discuss this with the physician , rather than experimenting on their own . He believes that treatment adherence is likely to be relatively high ( and stressed by nursing members of the multi-disciplinary team ) for those with ulcerative colitis given the strong desire to avoid a disease flare .
Q What are the treatments for more severe disease ?
A Amino-salicylates are no longer effective once ulcerative colitis becomes more severe and he suggested that when presented with patients who had very severe disease , particularly if they required hospitalisation , his approach would be to start them on a course of intravenous corticosteroids . Such patients , he said , require very close monitoring over the next few days and if they fail to respond to second and third-line treatments including immunosuppressants or an anti-tumour necrosis factor ( anti-TNF ) agent , then a colectomy is warranted to avoid more serious complications , for example , a colonic perforation .
Q How effective are the biologics in ulcerative colitis ?
A Dr Panés believes that the introduction of biologics has had a profoundly positive impact
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on the management of ulcerative colitis , both in the short- and long-term . He described how the first anti-TNF agent , infliximab , proved to be an effective treatment for those who had failed to adequately respond to other therapies . However , a limitation was that initially the drug was only approved for induction therapy and he observed that while effective , ‘ the majority of patients had a relapse two to three months later .’ Fortunately , later studies showed that the drug was effective as a maintenance treatment prompting a change in its approval . As a result , he said that now , any biologic is developed and studied for use in both induction and maintenance .
Q What was the rationale for using two biologics in the VEGA study ?
A Once the anti-TNF drugs had proven their worth in ulcerative colitis , other biologics were developed which had other targets . For example , vedolizumab inhibited α4β7 integrin and was an effective agent with a rapid onset of action . Another recognised target was the
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