Living guideline for moderate-to-severe ulcerative colitis

Ulcerative colitis affects nearly 2 million individuals in the United States and millions more worldwide. It has a protracted relapsing-remitting course with up to one-fifth of patients requiring colectomy and a third requiring hospitalization for management of their disease. Effective control of inflammatory activity is important to reduce disease-related morbidity. An important component of this effective control is an informed approach for therapy selection as first- or subsequent therapy. The past two decades have witnessed a significant expansion in the therapeutic armamentarium for moderate-to-severe UC. In the nearly two decades since the approval of the first biologic therapy (infliximab) for UC in 2005, there have been eleven additional advanced therapies approved for treatment of moderate-to-severe UC in the United States. Importantly, seven of these medications including two novel therapeutic classes, were approved since the publication of the most recent AGA guideline for treatment of moderate-to-severe UC in 2020. Two approved treatments addressed in prior guidelines (infliximab, vedolizumab) have also received approval for subcutaneous administration, and some drugs are available as biosimilars. Thus, the AGA prioritized updating the prior guidelines to provide recommendations for the pharmacological management of moderate-to-severe UC.