@shlepis thank you for the suggestion. I think I made this card back in 2023. Admittedly, know very little about UC and still know very little. I am happy to accept the suggestion to change it to testing only the first line management. A second card should also therefore potentially be created testing the second-line therapy.
However, eTG seems to suggest that thiopurines are added on “Once clinical remission of ulcerative colitis is achieved, the rate of relapse is significantly reduced (by approximately 50%) by maintenance therapy with a 5-aminosalicylate, with or without an immunomodulatory drug.” and the way it mentions “add” in “If a thiopurine is required for maintenance therapy of ulcerative colitis, add:”
Can you point me to a resource that suggests that they should be transitioned to a thiopurine (where it is a second line) instead?
It’s a really weird area of evidence from what I have found. My ‘second line’ comment is based on the vibe I’ve been getting from what I have been reading. I find that Clinical Gastroenterology: A practical problem-based approach by Nicholas Talley is a fantastic resource for all things gastro-related. It also implies that thiopurines are considered an alternative treatment to 5-ASA due to the deleterious metabolic byproducts and lymphoma risks (mainly used when patients cannot be weaned off the initial steroids). That being said, I did find an article in Nature (Ulcerative colitis | Nature Reviews Disease Primers) with a pretty flow chart that says it is added on (but published in 2020). New research and guidelines, such as those from the BMJ, also seem to recommend thiopurine separately from 5-ASA and even in conjunction with infliximab. Frankly, who knows, as it seems to be a rapidly changing area of evidence as of late.
Agree, it is potentially to nuanced to expect the average medical student to be tested on in exams nor to be of significant relevance to the average junior doctor. I think testing the first line maintenance therapy alone may be sufficient.