The new country also means a new IBD treatment centre for her. Stella is generally in stable clinical remission under maintenance therapy with mesalazine (2 g/day, oral). However, she recently had a mild flare-up, so her oral dose of mesalazine was increased to 4 g per day, and topical therapy was added. Since this also doesn’t help induce remission, he needs steroids. Because Stella has been diagnosed with osteopenia, she is concerned about systemic steroid therapy. He is thus started on treatment with budesonide MMX at 9 mg/day, which lasts for eight weeks and which leads to remission again.
Two III. also examined the efficacy of budesonide MMX in mild and moderate UC (CORE I and CORE II). No significant worsening of glucocorticoid symptoms was observed in these studies, suggesting that budesonide MMX at a daily dose of 9 mg is safe and more effective than placebo in inducing clinical and endoscopic remission.
However, after stopping budesonide MMX, Stella had a flare-up again. The severity of the flare reflects moderate to severe disease activity, and Stella reports no extra-intestinal manifestations, so vedolizumab treatment is initiated. The decision is also based on the phase IIIb VARSITY trial, which demonstrated superiority of vedolizumab to adalimumab in UC patients with moderately to severely active ulcerative colitis.
After one year of vedolizumab treatment, Stella was still in clinical and endoscopic remission, so she and her treating physician decided to discontinue vedolizumab and return to mesalazine maintenance therapy. As in the past, Stella could also maintain remission in this case.
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