Selecting ulcerative colitis therapies, with @DrCoreySiegel at @AmCollegeGastro #ACG2021
#GITwitter
Many considerations go into getting us to the right treatment for a given patient
Disease activity in ulcerative colitis
Disease activity 🆚 disease severity
Overall disease severity should be driving treatment decisions
🌟VARSITY: vedolizumab > adalimumab
🌟 SERENE-UC: no difference between standard and higher-dose adalimumab induction
Network meta-analysis:
Biologic naive: 🥇Infliximab 🥈vedolizumab
Anti-TNF exposed patients: 🥇ustekinumab, tofacitinib, 🥈vedolizumab 🥉adalumumab
VDZ has ⬇️ infection risk, tofacitinib and golimumab ⬆️ infection risk
Anti-TNF can be used effectively as first or second line.
Tofacitinib works rapidly, with effects seen as soon as 3 days in
Patients are more concerned about consequences of their disease than possible side effects of medications.
We should be explaining to patients *why* we are choosing the medications we recommend.
Patients accept a 1% risk of lymphoma to avoid a J-pouch, and a >5% risk to avoid ostomy. (Which is way higher than the actual risk of lymphoma- 9/10,000)
Still need to work on insurance companies...
Concluding the case
💎s from @DrCoreySiegel on selecting therapy in ulcerative colitis
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