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The only way is up?

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Ulcerative Colitis
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Posted 7/16/2013 6:08 PM (GMT -5)
Just thinking about IBD treatment in general.

The approach at my clinic is to start with the safer drugs and escalate if necessary.

It goes mesalazines>Immunosuppressants>biologics (not forgetting our good friend prednisolone but its not a maintenance drug)

Once you move up to the next course of treatment it seems that GI's are reluctant to move back down even if your symptoms are well under control.

So my question - is it that the only way is up in IBD treatment?

Post Edited (Jonny_Murray) : 7/16/2013 5:14:04 PM (GMT-6)

Posted 7/16/2013 7:16 PM (GMT -5)
I guess the belief is that if the safer drugs didn't get you to where you need to be then why go backwards in treatments?
Posted 7/16/2013 9:30 PM (GMT -5)
Some doctors are rethinking that strategy. Instead of the step-up therapy you described above, they suggest that it may be helpful for some patients (especially those with active UC throughout their colon) to try a top-down therapy where you go with the "big gun" medicine to see if you can get it under control quickly, and then if successful, try to step down to a first-line treatment.
Posted 7/17/2013 9:16 AM (GMT -5)
Yes jax, I've read about that approach too.

In my own case I started on just 200mg pentasa which as far as I can tell did nothing. I am now on aza and everything is completely under control - I feel great.

Looking back I wish I had just started on the aza straight away and I would have saved myself a whole lot of misery!

I just think in cases where a patient has sustained a good long term remission on the stronger treatments, it is worth at least considering stepping down on treatment given the long term risks of the meds.
Posted 7/17/2013 9:20 AM (GMT -5)
I've seen some members on here go back down. They were on Remi or Humira, discontinued the biologics once they hit a steady remission and maintain it with 5-ASA's.
Posted 7/17/2013 10:13 AM (GMT -5)
interesting that you list Immunosuppressants before biologics. I'm not sure my GI shares that thought.
Posted 7/17/2013 11:03 AM (GMT -5)
i think it is generally accepted that the biological drugs are a step up from aza and 6mp.
Posted 7/17/2013 8:51 PM (GMT -5)

JaxWentworth said...
Some doctors are rethinking that strategy. Instead of the step-up therapy you described above, they suggest that it may be helpful for some patients (especially those with active UC throughout their colon) to try a top-down therapy where you go with the "big gun" medicine to see if you can get it under control quickly, and then if successful, try to step down to a first-line treatment.

This might be a good idea if you assume that the medicine won't have any negative side effects. There's a good reason safer drugs are tried first.
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