Topical therapy is underused in patients with ulcerative colitis

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Pharmacology

Background:

• Topical therapies offer optimized treatment for left-sided ulcerative colitis with fewer side effects than systemic treatments.
• Rectal steroids and 5-aminosalicylic acid (5-ASA) show higher efficacy in left-sided colitis.
• Understanding current topical therapy usage is crucial for treatment optimization.

Purpose of the Study:

• To investigate the utilization patterns of topical versus oral therapy in patients with proctitis and left-sided colitis.
• To determine if topical treatment is more frequently used than oral therapy in specific ulcerative colitis disease extents.
• To assess the safety and efficacy of topical treatments in a real-world cohort.

Main Methods:

• Analysis of data from 800 patients in the Swiss IBD cohort study.
• Categorization of patients based on disease extent: proctitis, proctosigmoiditis, and pancolitis.
• Evaluation of topical, systemic, and combined treatment strategies, including 5-ASA and corticosteroids.

Main Results:

• Topical therapy use decreased with increasing disease extent, from 39% in proctitis to 13.1% in pancolitis.
• Topical 5-ASA dosage was higher in patients with severe colitis compared to those in remission.
• Side effects were less common with topical 5-ASA or budesonide compared to other medications, though topical treatment was often discontinued.

Conclusions:

• Topical treatment for proctitis in Switzerland is underutilized despite its safety and efficacy.
• There is a need to increase the use of topical therapies for appropriate ulcerative colitis patients.
• Topical treatments represent a valuable, safe, and effective option for optimizing ulcerative colitis management.