American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with ulcerative colitis who do not maintain remission, what therapy should be considered?

1. 5-aminosalicylate agents

2. Anti-TNF agents

3. Systemic glucocorticoids

4. Low-dose tricyclic antidepressants

The correct answer is: Anti-TNF agents

For patients with ulcerative colitis who do not maintain remission, considering anti-TNF agents is appropriate because these biologic therapies have been shown to be effective in inducing and maintaining remission in moderate to severe cases of ulcerative colitis. Anti-TNF agents, such as infliximab and adalimumab, target the tumor necrosis factor-alpha (TNF-alpha), which plays a crucial role in the inflammatory processes involved in ulcerative colitis. In circumstances where oral 5-aminosalicylate agents and systemic glucocorticoids either do not provide sufficient control or lead to adverse effects from long-term use, the use of anti-TNF therapy can offer a more targeted approach. The efficacy of anti-TNF agents has been established in clinical trials, demonstrating their ability to improve symptoms, induce mucosal healing, and reduce the need for corticosteroids. While systemic glucocorticoids can be effective in short-term management, they are typically not the go-to for long-term maintenance therapy due to potential side effects. Low-dose tricyclic antidepressants are not indicated for treating ulcerative colitis and are not relevant to this clinical decision-making process. Therefore, the selection of anti-TNF agents aligns with evidence