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Mild/moderate UC - best practice
On mild to moderate UC, Laurent Beaugerie reported that once daily oral 5-ASA is preferred by patients leading to improved treatment adherence and effectiveness. Benefits of combining enema and oral (2g bid) 5-ASA for extensive mild to moderate active UC are shown by higher remission rates at week 8: 64% for active enema (1g/day) vs 43% for placebo, p=0.02982. Similarly, improvement at week 8 was greater in the active enema arm (86% vs 68%, p=0.0256)2. For maintenance therapy, once daily 2g 5-ASA showed greater (71%) UCDAI remission rates at year 1 when compared to twice daily 1g 5-ASA (59%, p=0.0236)3. If rectal bleeding persists after 10 -14 days, dose escalation with 5-ASA, and/or a combination of topical 5-ASA with topical steroids or oral 5-ASA could be used. Patients who frequently relapse in spite of 5-ASA therapy, or are steroid-dependent, should be given immunosuppressants or biologics.