Millie Long, MD, on Management of Moderate to Severe Ulcerative Colitis

Dr Long reviews her talk on treating patients with moderate to severe ulcerative colitis, including the use of endoscopic severity and the course of disease to help define disease severity in ulcerative colitis and to choose therapeutic options for patients. She made this presentation at the Advances in Inflammatory Bowel Disease virtual regional meeting at Chapel Hill.

Millie Long, MD, is a professor of medicine at the University of North Carolina in Chapel Hill.

Dr. Millie Long:  Hello. My name is Millie Long. I'd like to thank those of you who just attended our Advances in IBD Regional Meeting in Chapel Hill. We really had a great course. For those of you that weren't able to attend, I just wanted to provide a brief recap on my presentation on "Management of Moderate to Severe Ulcerative Colitis."

The first key take-home point is that we really need to be using factors such as endoscopic severity and the course of their disease to help us to define disease severity in ulcerative colitis, meaning that we should no longer be looking just at their current symptoms in terms of disease activity but deciding on therapeutic options based on their broader disease severity.

We also discussed various agents in the management of ulcerative colitis. We discussed the role anti-TNF agents play, that they have differing efficacies in ulcerative colitis, but the evidence is robust that adding an immunomodulator to infliximab increases the efficacy of therapy, as shown in the UC success trial.

We also discussed the head-to-head VARSITY Trial, which compared vedolizumab to adalimumab at 52 weeks for outcomes of clinical remission and mucosal healing. This trial demonstrated a delta of approximately 10%, meaning that vedolizumab was more effective than adalimumab in this scenario.

We also discussed the newest SERENE data, which was a study looking at high-dose adalimumab and its role in the treatment of ulcerative colitis. In fact, in the study, it was found to have no difference for induction, meaning that the robust data from the VARSITY trial help us in terms of understanding comparative effectiveness at appropriate doses.

We also discussed the role that selecting therapies in subpopulations can play in the management of ulcerative colitis. What I mean by this is really considering special scenarios. If a woman is pregnant, if a patient has extra-intestinal manifestations, if an individual really prioritizes safety over efficacy, those factors play a huge role in therapeutic selection. We should be using those subpopulations to guide our choices.

And in fact, all of these choices should be made with a shared decision-making process with the patient. With that, I like to thank again those who were able to join us. Otherwise, we hope to see you at the Advances in IBD Meeting in December.