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KMID : 0988920180160040522
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Intestinal Research
2018 Volume.16 No. 4 p.522 ~ p.528
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Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy?Access to Rapid Treatment (iSTART) approach
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Danese Silvio
Banerjee Rupa
Cummings JR Fraser
Dotan Iris
Kotze Paulo G
Leong Rupert Wing Loong
Paridaens Kristine
Peyrin-Biroulet Laurent
Scott Glyn
Van Assche Gert
Wehkamp Jan
Yamamoto-Furusho Jesus K
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Abstract
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Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy?Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.
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KEYWORD
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Colitis, ulcerative, Consensus guidelines, Mesalazine, Corticosteroids, Patient reported outcome measures
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