Recommendations for research

The guideline committee has made the following recommendations for research. As part of the 2019 update, the guideline committee made an additional 3 research recommendations on inducing remission in mild-to-moderate ulcerative colitis.

Key recommendations for research

1 The effectiveness of immunomodulators in inducing remission in proctitis

In a mild-to-moderate first presentation or inflammatory exacerbation of proctitis that is resistant to standard treatment, what is the effectiveness of topical immunomodulators, such as tacrolimus, in achieving clinical remission and what is the most effective formulation (suppository/ointment)?

To find out why the committee made the research recommendation on immunomodulators for proctitis see rationale and impact.

2 The effectiveness of immunomodulators in unresponsive ulcerative colitis

What is the effectiveness of oral tacrolimus and systemic (intramuscular/subcutaneous/oral) methotrexate in the induction of remission in mild-to-moderate ulcerative colitis unresponsive to aminosalicylates?

To find out why the committee made the research recommendation on immunomodulators for unresponsive ulcerative colitis see rationale and impact.

3 The relative effectiveness of corticosteroids for inducing remission in ulcerative colitis

What is the clinical and cost effectiveness of prednisolone, budesonide, and beclometasone in addition to aminosalicylates compared with each other and with aminosalicylate monotherapy for the induction of remission for people with mild-to-moderate ulcerative colitis?

To find out why the committee made the research recommendation on corticosteroids for the induction of remission in mild-to-moderate ulcerative colitis see rationale and impact.

Other recommendations for research

From the 2019 update

Induction of remission for people with moderate ulcerative colitis: prednisolone compared with aminosalicylates

What is the clinical and cost effectiveness of prednisolone compared with aminosalicylates for the induction of remission for people with moderate ulcerative colitis?

Induction of remission for people with moderate ulcerative colitis: prednisolone compared with beclometasone

What is the clinical and cost effectiveness of prednisolone plus an aminosalicylate compared with beclometasone plus an aminosalicylate for induction of remission for people with moderate ulcerative colitis?

Induction of remission for people with subacute ulcerative colitis that is refractory to systemic corticosteroids

What are the benefits, risks and cost effectiveness of methotrexate, ciclosporin, tacrolimus, adalimumab and infliximab compared with each other and with placebo for induction of remission for people with subacute ulcerative colitis that is refractory to systemic corticosteroids?

From the 2013 guideline

What are the benefits, risks and cost effectiveness of methotrexate, ciclosporin, tacrolimus, adalimumab and infliximab compared with each other and with placebo for induction of remission for people with subacute ulcerative colitis that is refractory to systemic corticosteroids?

What is the clinical and cost effectiveness of regular maintenance treatment compared with no regular treatment (but rapid standard treatment if a relapse occurs) in specific populations with mild to moderate ulcerative colitis?

To develop and validate a risk tool that predicts the likelihood of needing surgery for adults admitted to hospital with acute severe ulcerative colitis.

In children and young people with ulcerative colitis receiving steroid treatment, what are the clinical benefits of routine monitoring of bone density, what tests should be done and how frequently?

A registry to collect data to answer 'What are the potential harms or benefits of drug treatments in pregnant women with ulcerative colitis?'

What are the information needs of people with ulcerative colitis when they are considering surgery?

What is the clinical and cost effectiveness of sulphasalazine compared to high-dose branded mesalazine for induction of remission for people with mild moderate ulcerative colitis?

What is the validity, reliability and accuracy of available adult risk tools as a predictor for the need for surgery in people admitted into hospital with acute severe ulcerative colitis?

What is the validity, reliability and accuracy of the paediatric ulcerative colitis activity index (PUCAI) as a predictor for surgery for children and young people admitted to hospital with acute severe colitis?

In people with mild to moderate ulcerative colitis, what are the best second-line treatment strategies for induction of remission after people have failed to respond to ASA mono or combination therapies?

In people with subacute ulcerative colitis, what are the best second-line treatment strategies for induction of remission after people have failed to respond to oral prednisolone?

In people with mild to moderate ulcerative colitis, what are the best strategies for the induction of remission after people have failed to respond to tacrolimus?

Establish a national registry to identify the incidence of growth failure and/or pubertal delay in ulcerative colitis and the relationship with treatment (to record treatment [steroids, ASA, immunomodulators] and growth [z scores]).

  • National Institute for Health and Care Excellence (NICE)