Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy-Access to Rapid Treatment (iSTART) approach

Danese S1, Banerjee R2, Cummings JF3, Dotan I4, Kotze PG5, Leong RWL6, Paridaens K7, Peyrin-Biroulet L8, Scott G9, Assche GV10, Wehkamp J11, Yamamoto-Furusho JK12. Intest Res. 2018 Oct;16(4):522-528. doi: 10.5217/ir.2018.00073. Epub 2018 Oct 16.

Author information

1 Inflammatory Bowel Disease Clinical and Research Unit, Istituto Clinico Humanitas, Milan, Italy.

2 Inflammatory Bowel Diseases Clinic, Asian Institute of Gastroenterology, Hyderabad, India.

3 Department of Gastroenterology, Southampton General Hospital, Southampton, UK.

4 Division of Gastroenterology at the Rabin Medical Center, Petah-Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel.

5 Colorectal Surgery Unit, Hospital Universitário Cajuru, Pontifical Catholic University of Paraná, Curitiba, Brazil.

6 Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.

7 Ferring Pharmaceuticals, Saint-Prex, Switzerland.

8 Inserm U954, Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-les-Nancy, France.

9 East Kent Hospitals Trust, Canterbury, UK.

10 UZ Leuven, Leuven, Belgium.

11 Department of Hepatology, Gastroenterology & Infectious Diseases, University Hospital Tuebingen, Tübingen, Germany.

12 IBD Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.


Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy-Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.

© Copyright 2013-2024 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.