Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition

Akyüz F.; An Y.K.; Begun J.; Aniwan S.; Bui H.H.; Chan W.; Choi C.H.; Chopdat N.; Connor S.J.; Desai D.; Flanagan E.; Kobayashi T.; Lai A.Y.H.; Leong R.W.; Leow A.H.R.; Leung W.K.; Limsrivilai J.; Muzellina V.N.; Peddi K.; Ran Z.; Wei S.C.; Sollano J.; Teo M.M.H.; Wu K.; Ye B.D.; Ooi C.J.

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition

Issued Date

2025-01-01

Resource Type

Review

ISSN

15989100

eISSN

22881956

DOI

10.5217/ir.2024.00089

Scopus ID

2-s2.0-85217886384

Journal Title

Intestinal Research

Volume

23

Issue

1

Start Page

37

End Page

55

Rights Holder(s)

SCOPUS

Bibliographic Citation

Intestinal Research Vol.23 No.1 (2025) , 37-55

Suggested Citation

Akyüz F., An Y.K., Begun J., Aniwan S., Bui H.H., Chan W., Choi C.H., Chopdat N., Connor S.J., Desai D., Flanagan E., Kobayashi T., Lai A.Y.H., Leong R.W., Leow A.H.R., Leung W.K., Limsrivilai J., Muzellina V.N., Peddi K., Ran Z., Wei S.C., Sollano J., Teo M.M.H., Wu K., Ye B.D., Ooi C.J. Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition. Intestinal Research Vol.23 No.1 (2025) , 37-55. 55. doi:10.5217/ir.2024.00089 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/105418

Title

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition

Corresponding Author(s)

Akyüz F.

Other Contributor(s)

Mahidol University

Abstract

The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

Keyword(s)

Medicine

URI

https://repository.li.mahidol.ac.th/handle/123456789/105418

Collections

Scopus 2025

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