Upcoming American Gastroenterological Association (AGA) guidelines on moderate-to-severe ulcerative colitis will simplify decision-making for clinicians faced with multiple new therapies and mechanisms. The recommendations will be presented on behalf of the guideline panel by co-chairs Ashwin Ananthakrishnan, MD, MPH, associate professor of medicine at Harvard Medical School and Siddharth Singh, MD, associate professor of medicine at the University of California, San Diego during Digestive Disease Week® (DDW) 2024.
“The field is evolving rapidly. New medications are being approved at an unprecedented rate, which is great news for patients and providers,” says Dr. Ananthakrishnan. “With these living guidelines, we hope to provide real-time guidance on how to incorporate these medications in clinical practice.”
“With the introduction of several new medications over the last couple of years, we are now able to think about how to position these agents based on their effectiveness and safety and additional specific patient factors,” says Dr. Singh.
There have been several advances in the treatment of ulcerative colitis since the last guideline, published in 2020, including FDA approval of five new medications with new mechanisms of action. Providers and patients now have several injectable and oral options to choose from.
“In 2020, it was hard to differentiate among the various treatment options,” says Dr. Singh. “There was a lot of overlap in effectiveness and safety. As the number of treatment options has increased, there is a bigger spread in terms of how effective they are. We can group the therapies based on their efficacy as well as parse out unique populations that they may or may not be appropriate for.”
In addition to new therapies, Drs. Singh and Ananthakrishnan will present recommendations on new treatment strategies, such as combining therapies and de-escalation strategies, as well as sequencing therapies.
“The focus of these guidelines is to narrow the gap between guideline and clinic,” says Dr. Ananthakrishan. “While guidelines have always been designed to influence clinical practice, they haven’t been as impactful in the clinic because they don’t provide the context providers need. We were particularly cognizant to narrow the gap between the guideline and clinical practice to make them as useful as possible.”
These are AGA’s first “living guidelines,” which are intended to allow rapid updating of individual recommendations as soon as new relevant evidence becomes available. Given the number of drug candidates being studied, the panel will revisit the recommendations every six months and update them if necessary in light of new data. Guidelines will be released for public comment before publication, following DDW.
Dr. Ananthakrishan stresses that these guidelines make up only a part of the management considerations for patients with ulcerative colitis. AGA guidelines on the role of biomarkers and therapeutic drug monitoring provide a complete picture. “Taken together, these three guidelines tell the story of how to care for somebody with ulcerative colitis. They’re very interlinked in their utility,” he says.
Dr. Ananthakrishnan’s and Dr. Singh’s oral presentation, “AGA living guidelines: management of moderate to severe ulcerative colitis,” on Sunday, May 19, at 11 a.m. EDT is part of the session “2024 AGA Guideline Highlights.”
