Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Toronto Consensus
Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Toronto Consensus
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DOI：
10.1053/j.gastro.2015.03.001
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发表时间：
2015-05-01
期刊：
影响因子：
29.4
通讯作者：
Feagan, Brian
中科院分区：
文献类型：
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作者：
Bressler, Brian;Marshall, John K.;Feagan, Brian
背景与目的：溃疡性结肠炎（UC）的医疗管理已通过开发新的治疗方法和优化现有药物的新方法得到改善。之前的加拿大共识指南讨论了住院患者中重度UC的管理。我们现在提出了治疗轻至重度活动性UC非卧床患者的共识指南。方法：系统的文献检索确定了关于UC管理的研究。根据推荐评估、发展和评价分级（GRADE）方法对证据质量和推荐强度进行评级。发言是通过一个互动的在线平台拟定的，然后由一个专家工作组定稿和表决。研究结果：参与者得出的结论是，治疗的目标是完全缓解，定义为症状和内镜下缓解，没有皮质类固醇治疗。共识包括34项声明，重点关注5种主要药物类别：5-氨基水杨酸（5-阿萨）、皮质类固醇、免疫抑制剂、抗肿瘤坏死因子（TNF）治疗和其他治疗。口服和直肠给药5-阿萨是轻中度UC的一线治疗推荐药物，对于未能达到缓解的患者，则采用皮质类固醇治疗。中重度UC患者应接受一个疗程的口服糖皮质激素治疗，成功达到症状缓解的患者可过渡至5-阿萨、巯基嘌呤、抗TNF（联合或不联合巯基嘌呤或甲氨蝶呤）或Vedolizumab维持治疗。对于糖皮质激素耐药/依赖性UC患者，建议使用抗TNF或Vedolizumab治疗。及时评估反应和缓解对于确保最佳结果至关重要。结论：UC的最佳管理需要仔细的患者评估，现有疗法的循证使用，以及彻底的评估来确定治疗成功。
BACKGROUND & AIMS: The medical management of ulcerative colitis (UC) has improved through the development of new therapies and novel approaches that optimize existing drugs. Previous Canadian consensus guidelines addressed the management of severe UC in the hospitalized patient. We now present consensus guidelines for the treatment of ambulatory patients with mild to severe active UC. METHODS: A systematic literature search identified studies on the management of UC. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a working group of specialists. RESULTS: The participants concluded that the goal of therapy is complete remission, defined as both symptomatic and endoscopic remission without corticosteroid therapy. The consensus includes 34 statements focused on 5 main drug classes: 5-aminosalicylate (5-ASA), corticosteroids, immunosuppressants, anti-tumor necrosis factor (TNF) therapies, and other therapies. Oral and rectal 5-ASA are recommended first-line therapy for mild to moderate UC, with corticosteroid therapy for those who fail to achieve remission. Patients with moderate to severe UC should undergo a course of oral corticosteroid therapy, with transition to 5-ASA, thiopurine, anti-TNF (with or without thiopurine or methotrexate), or vedolizumab maintenance therapy in those who successfully achieve symptomatic remission. For patients with corticosteroid-resistant/dependent UC, anti-TNF or vedolizumab therapy is recommended. Timely assessments of response and remission are critical to ensuring optimal outcomes. CONCLUSIONS: Optimal management of UC requires careful patient assessment, evidence-based use of existing therapies, and thorough assessment to define treatment success.