Doctors have released the first-ever “living” guideline for treating moderate-to-severe ulcerative colitis.
Living guidelines differ from traditional treatment guidelines in that they are updated more quickly as new research findings and suitable treatments become available. Instead of being revised every few years, living guidelines are updated as soon as new information emerges, ensuring patients always have access to the most current, evidence-based treatment recommendations.
The new guideline published by the American Gastroenterological Association (AGA) in its December publication shifts away from traditional step-by-step treatment approaches. It recommends that patients with moderate-to-severe ulcerative colitis start treatment immediately with advanced therapies, potentially shortening their path to relief.
New ‘Efficacy Buckets’ System
Published in Gastroenterology, the new guideline categorizes 12 advanced treatments for ulcerative colitis, simplifying treatment decisions for both physicians and the 1.25 million U.S. patients living with the condition.“AGA’s updated guidelines integrate both tried-and-true treatments and the latest advancements, offering patients and providers the most current recommendations for managing moderate-to-severe ulcerative colitis.”
The AGA introduced an “efficacy buckets” system to make treatment selection more efficient, grouping drugs with similar effectiveness. This approach aims to help clinicians select treatments based on their likelihood of inducing remission, regardless of how the drugs work.
Personalized Treatment Factors
According to the new guideline, key factors influencing treatment decisions will include a patient’s risk of disease complications, disease severity, and other considerations such as comorbidities, patient age, safety risks, and pregnancy status.Shift in Treatment Approach
In a departure from traditional methods, AGA now recommends patients with moderate-to-severe ulcerative colitis begin therapy with advanced treatments or immunomodulators (substances that can either stimulate or suppress the immune system) rather than following the conventional step-up approach when 5-aminosalicylates (5-ASAs) fail. The previous step-up approach required trying weaker classes of medications first and progressing to stronger medications if needed.For patients who haven’t previously received advanced therapies, the guideline indicates that medications with high efficacy include infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, and guselkumab.
For patients with prior exposure to advanced therapies, particularly those who have experienced tumor necrosis factor (TNF)-alpha antagonist failure—where the drug doesn’t offer sufficient symptom relief—the guideline states that the most effective medications are tofacitinib, upadacitinib, and ustekinumab.
Ananthakrishnan explained why the new guideline is considered a “living document.”
“[This] means that new data will be reviewed periodically, [it’s] anticipated [to be] every 6 months,” he wrote in the email, noting that as sufficient new data that may affect the guideline statement becomes available, the corresponding statement will be updated, even if the rest of the guideline remains unchanged.
“For example,“ he wrote, ”if new head to head trials are available, or new drugs have published phase 3 data and are anticipated to be approved.”
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