Oct 12, 2010

New keys to maintenance treatment in ulcerative colitis

Digestive Diseases
Peter D R Higgins

Abstract

Maintenance treatment in ulcerative colitis often fails to prevent flares and long term complications. The first key to maintenance is to use effective therapy, even when patients become asymptomatic. The second key is to communicate the importance of adherence to patients, and to help them achieve long term adherence. Simplified dosing schedules are of some benefit, but the bond between patient and doctor, and the patient's belief in the efficacy of the therapy are essential. Decreased co-pays (a fixed amount paid by patients seeking care that is not reimbursed my medical insurance) have been associated with increased adherence, and incentives for patients may be a cost-effective approach to improving adherence. While the most substantial data on the association between adherence and clinical outcomes is in 5-ASAs, non-adherence can also limit the efficacy of thiopurines and biologics. The third key to maintenance treatment is monitoring and maintaining control of inflammation. Decreased histologic and endoscopic damage to the colon has been associated with decreased risk of colon cancer. The most cost-effective way to monitor smoldering inflammation is not known, but endoscopy, structured symptom indices, and biomarkers may b...Continue Reading

  • References18
  • Citations2

References

  • References18
  • Citations2

Mentioned in this Paper

Patient Non-Compliance
Endoscopy (Procedure)
Immunomodulators
Immunologic Adjuvants
Biological Products
Malignant Tumor of Colon
Recurrent Malignant Neoplasm
Colorectal Neoplasms
Recurrence (Disease Attribute)
Inflammation

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