What is a common induction therapy for moderate to severe ulcerative colitis with systemic symptoms?

• A. Systemic corticosteroids (e.g., prednisone)
• B. Budesonide
• C. Mesalamine
• D. Azathioprine

Answer: (A)

When a patient with ulcerative colitis presents with moderate to severe disease and systemic symptoms, the goal is rapid control of inflammation. Systemic corticosteroids are the standard induction therapy because they work quickly to suppress widespread intestinal inflammation and the accompanying systemic inflammatory response, leading to faster symptom relief and clinical remission.

Budesonide, while a corticosteroid, has extensive first-pass metabolism that limits its systemic effects. This makes it useful for milder disease or disease confined to specific segments (like limited left-sided colitis), but it’s not as effective for inducing remission in moderate to severe UC with systemic symptoms.

Mesalamine (5-aminosalicylic acid) is effective for mild disease and maintenance therapy, but it generally doesn’t induce remission in moderate to severe disease with systemic involvement.

Azathioprine is an immunomodulator with a slower onset and is mainly used for maintenance and steroid-sparing strategies, not as the initial induction therapy for acute moderate-severe disease.

In some patients who do not respond to steroids, other therapies (like biologics or calcineurin inhibitors) may be considered, but the first-line induction choice in this scenario is systemic corticosteroids due to their rapid and robust anti-inflammatory effects.