Discontinuation of Treatment in Ulcerative Colitis

General Principles for Maintenance Therapy

The European Crohn’s and Colitis Organisation recommends lifelong maintenance therapy for all patients with ulcerative colitis, particularly those with left-sided or extensive disease 1, 2
Patients with distal disease who relapse more than once a year should remain on maintenance therapy indefinitely, as recommended by the European Society of Gastrointestinal Endoscopy 1
Maintenance therapy should be continued with the agent successful in achieving induction, with the exception that corticosteroids are not recommended for long-term maintenance, according to the American Gastroenterological Association 3

Discontinuation of medication may be reasonable for patients with distal disease who have been in stable remission for at least 2 years, as suggested by the American College of Gastroenterology 1, 2
Disease extent is a factor to consider before stopping therapy, with distal disease having a better prognosis than extensive disease, according to the European Crohn’s and Colitis Organisation 1, 3
Previous disease severity and frequency of relapses should be considered before stopping therapy, as recommended by the American Gastroenterological Association 4
Patient preference regarding medication continuation should be taken into account, according to the European Society of Gastrointestinal Endoscopy 2

For patients in remission on 5-ASA, continuation is generally recommended at a dose of at least 2 g/day, as suggested by the American College of Gastroenterology 4
Corticosteroids should never be used for maintenance therapy, according to the American Gastroenterological Association 4
Prednisolone should be reduced gradually according to severity and patient response, generally over 8 weeks, as recommended by the European Crohn’s and Colitis Organisation 1

Treatment should be stopped and surgical options considered when there is no response to maximal oral treatment with mesalazine and/or steroids with or without topical therapy, as recommended by the American College of Gastroenterology 1
Treatment should be stopped and surgical options considered when there is no response to intravenous steroids within 3-5 days, according to the European Crohn’s and Colitis Organisation 7

Patient education about recognizing early signs of relapse is essential, as recommended by the American Gastroenterological Association 4
Prompt reinitiation of therapy is necessary if symptoms recur, according to the American College of Gastroenterology 4

Continuing corticosteroids for long-term maintenance is associated with significant adverse effects and should be avoided, as recommended by the American Gastroenterological Association 4
Stopping therapy prematurely in patients with extensive disease or frequent relapses should be avoided, according to the European Crohn’s and Colitis Organisation 1
Continuing 5-ASAs in patients who have failed these agents and escalated to advanced therapies, unless they have residual proctitis, should be avoided, as recommended by the American College of Gastroenterology 5