ULCERATIVE COLITIS - Guideline Update
The NHSGGC guideline Ulcerative Colitis: Use of Biologic Agents and Small Molecules to Treat Adult Patients in an Outpatient Setting (previously entitled ‘Ulcerative Colitis: Use of Biological Agents in Adult Patients’) has been updated.
The guideline includes information on the biologic agents and small molecule (non-biologic) licensed for treating adult patients with moderately to severely active ulcerative colitis (UC) in the outpatient setting. See table below.
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| Biologic agents | Small molecule | |||||
|
Drug name (route of administration) |
Infliximab (IV or SC) |
Adalimumab (SC ) |
Golimumab (SC) |
Vedolizumab (IV or SC) |
Ustekinumab (SC) |
Tofacitinib (oral) |
| Mechanism of action | TNF-α inhibitor | Integrin inhibitor (α4β7) |
IL-inhibitor (IL-12 and IL-23) |
JAK-inhibitor (JAK1 and JAK3) |
||
Summary of main changes
- Information added on newly licensed agents (ustekinumab and tofacitinib) and newly licensed routes of administration for infliximab (SC route) and vedolizumab (SC route)
- New tables added to summarise information on individual agents, including: GGC formulary restrictions, contraindications and cautions, data for use in pregnancy and breast feeding and comparison of agents
- Link to further information on therapeutic drug monitoring for available agents
- New checklist and consent form for patients commencing on these treatments
Key messages
- Treatment should be initiated and reviewed by specialist clinicians with experience of these agents and managing UC
- Patients should be followed up by regular clinical review by the consultant gastroenterologist to ensure there is an ongoing indication for continued prescription and to monitor for adverse effects
- Biosimilar IV infliximab and biosimilar SC adalimumab are the most cost effective treatment options and remain GGC 1st line agents of choice
- As with other Outside drugs, these medicines should be added to GP prescribing systems (see here for further information). GPs should refer to the individual Summary of Product Characteristics (SPCs) (available from www.medicines.org.uk) for further information on adverse effects and drug interactions.
For further information refer to the full guideline available here.
Published 20/08/2021. Links updated 09/03/2022.
Medicines Update blogs are correct at the time of publication.