Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice

Actualización de la guía de práctica clínica PANCCO para el tratamiento de la colitis ulcerativa en población adulta

Resumen: La colitis ulcerativa (CU) es una enfermedad crónica de etiología desconocida, incurable, su curso clínico es intermitente, caracterizado por periodos de remisión y recaídas, su prevalencia e incidencia mundial ha venido incrementando. En esta actualización participaron profesionales de la salud, tomadores decisiones y un representante de los pacientes. Todos los involucrados declararon sus conflictos de interés. Se formularon preguntas clínicas contestables y se graduaron los desenlaces. La pesquisa de la información se realizó en Medline/PubMed, Embase, Epistemonikos y LILACS. La búsqueda también abarcó fuentes de literatura gris y se actualizó el 30 de noviembre de 2020 sin restricciones por fecha o idioma. Se implementó la aproximación Grading of Recommendations Assessment, Development and Evaluation (GRADE) para establecer la calidad de la evidencia y la fuerza de las recomendación. Se realizó consenso formal implementando la metodología RAND/UCLA. El documento fue objeto de revisión por pares. Se presenta aquí la versión corta de la Guía de Práctica Clínica para el Tratamiento de la Colitis Ulcerativa en Población Adulta, junto con la evidencia de apoyo y las recomendaciones respectivas. En CU leve a moderada, la budesonida MMX es una opción en caso de falla a 5-ASA, y antes de usar esteroides sistémicos. En CU moderada a severa, infliximab y adalimumab, vedolizumab, ustekinumab y tofacitinib pueden ser usados como terapia de primera línea. En caso de falla a anti-TNF, los mejores resultados son con ustekinumab y tofacitinib. En pacientes con reservoritis refractaria a antibióticos, el tratamiento de elección son los anti-TNF. Abstract: Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice