An interesting, long read on research-based, best practice of managing UC patients.
Sounds like they are saying:
2a.) Recommend: Infliximab/remicade or vedolizumab/entyvio rather than adalimumab/humira, for the first biologic for the induction of remission.
2b.) Caution with tofacitinib/xeljanz for first biologic, clots/PE. Okay for 2nd biologic.
2c.) If previously exposed to infliximab/remicade, particularly those with primary non-response, the AGA suggests
using stelara/ustekinumab or tofacitinib/xeljanz, rather than vedolizumab/entyvio or adalimumab/humira for induction
3a.) Recommend against thiopurine (aza/imuran/6mp) monotherapy for mod/severe UC.
6.) In adult outpatients with moderate-severe ulcerative colitis, the AGA suggests early use of biologic agents with or without immunomodulator therapy, rather than gradual step up after failure of 5-aminosalicylates. No surprises here, if you're moderate/severe then expect biologics early on. The top-down approach is gaining more strength in clinical practice. If you're mild, sure try the 5-ASA/mesalamines first. However, the biologics are gaining more prominence and recommended to be tried much earlier, often 1st line treatments for mod/severe cases.
Long document, but those I found the most interestinghttps://www.gastrojournal.org/article/s0016-5085(20)30018-4/pdf