preferred over systemically active glucocorticoids. Oral budesonide MMX is also safe and more effective than placebo in inducing remission in patients with mildly active UC. In a prospective RCT, patients given 9 or 6 mg budesonide MMX or 5-ASA achieved clinical remission 17.9%, 13.2%, and 12.1% of the time, respectively, compared with 7.4% in the placebo group (P = 0.0143, P = 0.1393, and P = 0.2200, respectively) (98). Adherence to medication is a factor in relapse in patients with mildly active UC. A meta-analysis of 3 trials found no significant differences in efficacy or adherence between once-daily and conventionally dosed 5-ASA for induction of remission in patients with UC (nonremission RR, 0.95; 95% CI, 0.82–1.10) (97,105). However, clinical trial populations are known to have higher adherence rates than clinical practice settings. The prevalence of nonadherence in the community is high (40%), reaching up to 68% in patients on more than 4 prescription medications (106). An RCT found that patients with proctosigmoiditis preferred once-daily 5-ASA dosing over 3-times-daily dosing. Patients also had a significantly higher rate of clinical remission in the once-daily dose group (86%; n = 97) vs the t.i.d. group (73%; n = 100; P = 0.0298) (107). Therefore, reinforcement of compliance is an important aspect of management of UC, and any means to optimize adherence should be used, including discussing once-daily dosing options with patients, given these data on similar efficacy and safety. In patients with mildly to moderately active UC, on appropriately dosed 5-ASA, probiotic VSL#3® at a daily dose of 3.6 × 1012 CFU/d has been studied as an adjunct to 5-ASA therapy to improve symptoms compared with no treatment. In a meta-analysis from 2017 including 22 studies of probiotics in the treatment of IBD, there was no benefit of probiotics in general for induction of remission. However, when only studies of VSL#3® were included (n = 3), there did seem to be a benefit (RR, 0.74; 95% CI, 0.63–0.87) in these small studies. All these studies were at risk of bias, and the quality of the evidence was too low to make a recommendation for or against the use of VSL#3® in UC (108). In 1 clinical trial using VSL#3® as add-on therapy to 5-ASA, endoscopic improvement was not achieved (109). A meta-analysis of 3 studies found that treatment with E. coli Nissle 1917 was comparable to 5-ASA therapy in patients with inactive UC (RRpooled, 1.08; 95% CI, 0.86–1.37) (110). Similar methodological concerns for these studies exist, including small sample size, risk of bias, and high degree of heterogeneity, limiting the level of evidence supporting this intervention. The control population included placebo or 5-ASA. However, the comparison doses of 5-ASA were often ≤1,500 mg (less than a recommended maintenance dose). In 1 clinical trial, patients with UC randomized to E. coli Nissle were less likely than those on placebo to reach remission (111). Therefore, there is not sufficient evidence to recommend for or against E. coli Nissle for induction of remission of UC. Similarly, FMT has showed some promising data in the treatment of UC and has been studied in 3 RCTs (112–114). These trials of FMT in UC have different designs, delivery mechanisms, donor types, and inclusion criteria. The RCTs for FMT have had variable benefits but not significant steroid-sparing effects. The variability in fecal donors, delivery systems, duration of treatment, and end points makes interpretation of these results