Mild-to-Moderate Ulcerative Colitis: Your Role in Patient Compliance and Health Care Costs

BACKGROUND: Ulcerative colitis (UC) is a chronic relapsing disease necessitating lifelong treatment. Most patients present with mild-to-moderate disease characterized by alternating periods of remission and clinical relapse. Continued disease progression and relapse of UC overtime are associated with an increased risk of colorectal cancer (CRC). OBJECTIVES: To discuss the latest treatment options for mild-to-moderateUC, to review the current data involving the economics of UC, and to demonstrate the relationship between treatment adherence, clinical relapse, inflammation severity, CRC risk, and treatment outcomes. SUMMARY: One of the main goals of therapy in UC is to induce and maintain a long-lasting remission of disease to reduce or avoid the high personal and financial costs of relapse. In recent studies, researcher shave demonstrated a link between increased colonic inflammation andCRC risk, highlighting the importance of preventing relapse, which can lead to costly surgical procedures and hospital stays and thus increase the cost of treatment 2- to 20-fold. The risk of disease relapse is affected by several factors, of which the most prominent is non-adherence to maintenance therapy. Non-adherence to therapy can be associated with several other factors, including forgetfulness, male sex, complicated dosing regimens, treatment delivery methods (oral vs. rectal), and pill burden. In the treatment of mild-to-moderate UC, 5-aminosalicyclic acid(5-ASA) is the standard first-line therapy and the treatment of choice for maintaining remission of disease. Novel formulations of 5-ASA and newly devised high-dose 5-ASA regimens offer more options for the treatment ofUC and thus may lead to improved treatment adherence, longer remission,and improved patient well-being. CONCLUSIONS: Periods of remission during UC treatment must be aggressively maintained to prevent relapse and decrease the risk of a nonfavorable outcome. By controlling the risks and conditions that lead to therapeutic non-adherence and relapse among patients with UC, clinician scan increase the likelihood of long-term remission and ensure favorable long-term outcomes.