Ulcerative Colitis Case Study

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Introduction:
UC is a chronic idiopathic inflammatory disease of the gastrointestinal tract (GIT) that involves the large intestine and is a major disorder under the broad group of conditions termed inflammatory bowel disease, which also includes Crohn’s disease (CD). Dr. Samuel Wilks was the first to distinguish Ulcerative Colitis (UC) in 1859 when he described on “idiopathic colitis” and it has distinct features from the most common bacillary dysentery [1]. In that year, Sir Arthur Hurst wrote a complete description of Ulcerative Colitis which includes its sigmoidoscopy manifestations and distinction from bacillary dysentery [2].Ulcerative colitis is treating conventionally with 5-aminosalicylic acid (ASA), corticosteroids and oral immunosuppressant
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Moreover, we are executed sub-analysis within this meta-analysis to account for whether the control group received placebo or active intervention.
Ulcerative Colitis therapy has an essential goal by the induction and maintenance of long-term corticosteroid-free clinical remission whereas mucosal healing is considered as one of the main goals of UC treatment as well since it has been associated with improved patient outcomes[20, 21]. Efficacy of Aminosalicylates and corticosteroids has shown for the induction of clinical remission.
However, up to 20% of UC patients become steroid dependent at the first year of the initial treatment[22, 23]. Azathioprine (AZA) and mercaptopurine (6MP) are immunosuppressants (IS), most commonly used for maintenance therapy of long-term steroid-free clinical remission, as recommended by the European Crohn’s and Colitis Organization guidelines
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Antibodies directed against TNF-α include infliximab (IFX), a monoclonal chimeric antibody, adalimumab (ADA) and golimumab (GLM), both humanized monoclonal antibodies. These therapy agents have been proven to be effective for obtaining and maintaining clinical remission in UC [10-12, 14, 15].
In ulcerative colitis, the benefit of the combination of anti-TNF-α agents with an IS (combination therapy) remains debated.
In Crohn’s disease (CD), the SONIC trial, reported that there is superiority of combined IFX and AZA therapy over IFX therapy alone for IS naive patients[27]. Likewise, the SUCCESS trial reported a significantly higher 16 weeks’ steroid-free clinical remission rate for the combination therapy compared to IFX alone, for moderate-to-severe active ulcerative colitis[28].
The post hoc analysis of the ACT 1 and 2 trials reported that 6 and 12 month remission rates are not affected by combination therapy[29]. However, a new prospective cohort study from Armuzzi et al. reported that combined IFX-AZA treatment was a predictor of steroid-free clinical remission at 6-12 months [30]. Whether all patients with UC, regardless of their prior IS status, should benefit from combination therapy remains

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