AGA Living Guideline for Moderate-to-Severe Ulcerative Colitis –The Good and The Bad

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S Singh et al. Gastroenterol 2024; 167: 1307-1343. Open Access! AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis

This is a recent clinical guideline intended to serve as the starting point of a “living guideline” for adults with moderate-to severe ulcerative colitis.

  • The good news is that the AGA plans to update these guidelines semi-annually. The bad news is that this guideline does not provide the best advice.
  • It lumps recommended treatments into broad categories rather than indicating which therapies have the most effectiveness.
  • It is useful that the guidelines specifically recommend against step up therapy.
FDA labelling recommends upadacitinib only in patients who have not responded to anti-TNF therapy

For a recent study that provided more direction into which medications are most effective for both UC and Crohn’s disease: PS Dulai et al. Gastroenterol 2024; 166: 396-408. Open Access! Integrating Evidence to Guide Use of Biologics and Small Molecules for Inflammatory Bowel Diseases (Summarized in blog post: Comparative Evidence and Positioning Advance Therapies for Inflammatory Bowel Disease)

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