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用于轻度至中度溃疡性结肠炎管理的共享决策制定的算法。

Algorithms to facilitate shared decision-making for the management of mild-to-moderate ulcerative colitis.

机构信息

a Department of Gastroenterology , The Austin Hospital , Melbourne , Australia.

b Department of Medicine, Austin Academic Centre , University of Melbourne , Melbourne , Australia.

出版信息

Expert Rev Gastroenterol Hepatol. 2018 Nov;12(11):1079-1100. doi: 10.1080/17474124.2018.1530109. Epub 2018 Oct 17.

Abstract

Nonadherence has been a key barrier to the efficacy of medical treatments in ulcerative colitis (UC). Engaging patients in their IBD care via shared decision-making (SDM) to facilitate self-management may improve adherence to therapy. Areas covered: This review aims to summarize the most recent trial evidence from 2012 to 2017 for mild-to-moderate UC in order to develop clinical algorithms that guide SDM to facilitate self-management. A structured literature search via multiple electronic databases was performed using the search terms 'ulcerative colitis,' 'treatment,' 'management,' 'medication,' 'maintenance,' 'remission,' '5-ASA,' and 'inflammatory bowel disease. Expert commentary: Novel formulations of existing oral and topical medications have expanded the treatment options available for the induction and maintenance therapy for mild-to-moderate UC. Daily dosing of 5-ASA therapy is equivalent to twice daily dosing. The combination therapies of oral plus topical 5-ASA therapy and 5-ASA plus corticosteroid therapy are more effective than monotherapy. Budesonide MMX now plays a role in the management of mild-to-moderate UC. This review collates the evidence on drug efficacy and safety, adherence and tolerability, and noninvasive monitoring of mild-to-moderate UC into SDM-orientated algorithms to facilitate self-management.

摘要

不遵医行为一直是溃疡性结肠炎(UC)疗效的主要障碍。通过共同决策(SDM)使患者参与到他们的 IBD 治疗中,以促进自我管理,可能会提高治疗的依从性。

涵盖领域

本综述旨在总结 2012 年至 2017 年轻度至中度 UC 的最新临床试验证据,以制定指导 SDM 促进自我管理的临床算法。通过多个电子数据库进行了结构化文献检索,使用的检索词为“溃疡性结肠炎”、“治疗”、“管理”、“药物”、“维持”、“缓解”、“5-ASA”和“炎症性肠病”。

专家评论

现有口服和局部药物的新制剂扩大了轻度至中度 UC 的诱导和维持治疗选择。每日剂量的 5-ASA 治疗与每日两次剂量相当。口服加局部 5-ASA 联合治疗和 5-ASA 加皮质类固醇治疗的联合疗法比单一疗法更有效。布地奈德 MMX 现在在轻度至中度 UC 的治疗中发挥作用。本综述将药物疗效和安全性、依从性和耐受性以及轻度至中度 UC 的非侵入性监测方面的证据整理成 SDM 导向的算法,以促进自我管理。

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