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Ulcerative Colitis

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Figure 5 Short course of steroids with initiation of thiopurine Options: • Thiopurine and taper steroids over 60 days • Anti-TNF, with or without thiopurine • Vedolizumab, with or without thiopurine or methotrexate Remission Anti-TNF, with or without thiopurine a,b Vedolizumab, with or without immunomodulator c Continue anti-TNF, with or without thiopurine Continue vedolizumab, with or without immunomodulator Maintenance Therapy Inductive Therapy No Remission Relapse Therapy for High-Risk Outpatient Not in Remission Therapy for High-Risk Outpatient Not in Remission 6 6 Inductive and Maintenance Therapy (High Risk, Outpatient) 5 Figure 5 and 6 Footnotes a Combination therapy with a thiopurine is more efficacious than anti-TNF monotherapy and should be considered, especially in patients who have failed one or more anti-TNF agents. b Extrapolating from data in Crohn's disease, methotrexate may be used instead of thiopurines to decrease anti-TNF immunogenicity. c Extrapolating from data with anti-TNF agents, thiopurines and methotrexate may be used to decrease vedolizumab immunogenicity. d e addition of allopurinol (while decreasing the thiopurine dose to 1/4 of the previous dose) may be considered at centers with experience with this approach and recognizing the risks of severe myelosuppression and infection. Remission Remission Colitis

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