Last, what are living guidelines? 🧑🍼
🔹 With how quick drug-development 💊 and treatment strategies ♟️ change, AGA will review new lit. 📄 and update recommendations 📝 as needed every 6 months.
Stay tuned for updates in the future!
9/9
✳️11-12 . For TNF + IMM therapy, when should you stop?
❌ stop TNF if combo therapy
🤷♂️ Knowledge gap: no recommendation on continuing IMM or when to stop 🗓️
✳️13. For patients w/ mod-severe disease:
👍 Early advanced therapy
❌ No step-up 🪜 therapy
✳️14 If now on advanced 💊, stop 5-ASAs
8/9
✳️8, ✳️9, ✳️10 Combo therapy 💊+💊
🔹 TNF + immunomodulator > TNF or IMM alone
🤷♂️Knowledge gap: no recommendation about whether IMM + non-TNF biologic is helpful
7/9
✳️5, ✳️6, ✳️7. Immunomodulators 💊
❌ Thiopurines for induction
👍 Okay to use thiopurines for maintenance
❌ Methotrexate for induction or maintenance
6/9
❗️Important Points❗️
❗️High🪣or med🪣 are recommended over lower🪣, but high🪣 is not necessarily > med 🪣
❗️Factor in pt attributes when making tx choices, not just focusing efficacy buckets:
👨🦳age
🤰pregnancy status
🤒comorbidities
👩🦽functional status
🔅patient preferences
5/9
What about comparative efficacy for bio-naïve & bio-exposed?
✳️3. Bionaïve💉💊
High🪣: IFX, VDZ, OZA, ETR, UPA, RISA, GUS
Med🪣: GOL, UST, TOFA, FIL, MIRI
Lower🪣: ADA
✳️4. Exposed💉💊
High🪣: TOFA, UPA, UST
Med🪣: FIL, MIRI, RISA, GOL
Low🪣: ADA, VDZ, OZA, ETR
4/9
✳️1 & ✳️2: What is efficacy of 💊 compared to placebo for all-comers?
High🪣: IFX, GOL, VDZ, TOFA, UPA, UST, OZA, ETR, RISA, GUS
Med 🪣: ADA, FIL, MIRI
Caveats 🔦
1. JAKis often 🙅♂️ for 1st line use per FDA
2. Biosimilar= originator
3. SC = IV
3/9
But first, details 🤓
📍Developed using GRADE framework
📍Thresholds for clinically meaningful benefits across all 💊: >10% vs. pbo & >5% vs. other 💊
📍Provides guidance by stratifying of meds into 🪣s: high-, intermediate-, and lower-efficacy, for biologic-naïve and -exposed patients
2/9
🚨AGA New Guideline Alert🚨
🔗https://tinyurl.com/4dr3y5ms
▶️AGA Living Guideline: Pharmacological Management of Moderate-Severe Ulcerative Colitis
I’ll break down its 14 recommendations down over the next 9 tweets 🧵 👇
#AGA #GI #UC #IBD
1/9
