Induction therapy for mild to moderate extensive ulcerative colitis in adults

For patients with mild to moderate extensive ulcerative colitis, the combination of a rectal and an oral 5-aminosalicylate leads to more rapid remission than oral therapy aloneMarteau, 2005Adamina, 2020. Use:

mesalazine 1 to 4 g rectally, daily in a single dose or 2 divided doses (see Rectal mesalazine preparations and dosages for ulcerative colitis in adults for formulations) mesalazine mesalazine mesalazine

PLUS ONE OF THE FOLLOWING

1mesalazine 2 to 4.8 g orally, daily in a single dose or 2 divided doses (see Oral 5-aminosalicylate preparations and dosages for ulcerative colitis in adults for formulations) mesalazine mesalazine mesalazine

OR

2sulfasalazine 2 to 4 g orally, daily in a single dose or 2 divided doses (see Oral 5-aminosalicylate preparations and dosages for ulcerative colitis in adults for formulations) sulfasalazine sulfasalazine sulfasalazine

OR

3balsalazide 6.75 g orally, daily in a single dose or 2 to 3 divided doses (see Oral 5-aminosalicylate preparations and dosages for ulcerative colitis in adults for formulations) balsalazide balsalazide balsalazide

OR

3olsalazine 1.5 to 3 g orally, daily in a single dose or 2 divided doses (see Oral 5-aminosalicylate preparations and dosages for ulcerative colitis in adults for formulations). olsalazine olsalazine olsalazine

For patients who do not respond to 5-aminosalicylate therapy alone or those with moderate extensive ulcerative colitis, add an oral corticosteroid. Use:

prednisolone (or prednisone) 40 to 50 mg orally, daily in the morning until clinical response, then taper over 5 to 8 weeks to cease. prednisolone prednisolone prednisolone

For patients with a history of adverse reactions to systemic corticosteroids or precautions to their use (eg diabetes), consider using the multimatrix system (MMX) preparation of budesonide (eg Cortiment)12Lichtenstein, 2015Sandborn, 2012Travis, 2014. Use:

budesonide MMX 9 mg orally, daily for 4 to 8 weeks depending on clinical response. budesonide budesonide budesonide

Some specialists taper budesonide MMX dosage by administering on alternate days for 2 to 4 weeks before stopping.

Refer patients who do not respond to an oral corticosteroid with 5-aminosalicylate therapy to a gastroenterologist.

1 At the time of writing, the multimatrix system (MMX) preparation of budesonide is not available on the Pharmaceutical Benefits Scheme (PBS). See the PBS website for current information.Return
2 Other preparations of oral budesonide (eg Entocort, Budenofalk) are not interchangeable with the MMX formulation (eg Cortiment), because they have different release characteristics.Return