New Treatments for Ulcerative Colitis
Ulcerative colitis (UC), a chronic
inflammatory bowel disease, continues to be the subject of extensive
scientific research as medical professionals seek better ways to manage
this challenging condition. Recent developments include FDA approval of
new medications, with researchers actively studying additional
treatments in clinical trials.
The primary goal of UC treatment is to stop
the immune system from attacking the intestinal lining, thereby
reducing inflammation, alleviating symptoms, and achieving remission.
Doctors now have an expanding arsenal of medications to help patients
reach these objectives.
Current Treatment Options
Treatment selection depends on several factors: disease severity (mild,
moderate, or severe), previously tried medications, response to those
treatments, and overall health status.
Aminosalicylates (5-ASA Drugs)
Aminosalicylates represent the first-line treatment for UC, containing
the active ingredient 5-aminosalicylic acid (5-ASA). This category
includes mesalamine (Apriso, Asacol HD, Canasa, Pentasa), olsalazine
(Dipentum), balsalazide (Colazal), and sulfasalazine (Azulfidine).
These medications, taken orally or as enemas, reduce intestinal
inflammation and work best for mild to moderate UC. They have
demonstrated effectiveness in both inducing and maintaining remission.
The American Gastroenterological Association (AGA) strongly recommends
that adults with mild to moderate UC choose a standard dose of oral
mesalamine, olsalazine, or balsalazide over low-dose mesalamine,
sulfasalazine, or no treatment. A standard mesalamine dose is 2 to 3
grams daily.
Recent research examining UC prevalence in the Middle East called 5-ASA
"the gold standard for the induction of remission in patients with mild
to moderate UC according to multiple international guidelines,"
reinforcing the AGA's recommendation.
Corticosteroids
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Corticosteroids suppress the immune system to reduce inflammation and
are typically used for patients hospitalized with acute severe UC.
Examples include prednisone (Prednisone Intensol, Rayos), prednisolone
(Prelone, Millipred), methylprednisolone (Medrol), and budesonide
(Uceris).
Doctors may also prescribe these medications short-term to manage
symptom flares. Administration methods include oral tablets, injections,
intravenous infusion, and rectal foam.
However, long-term steroid use isn't advisable due to potential side
effects including high blood sugar, weight gain, infections, and bone
loss. Patients should discuss these risks and treatment timelines with
their healthcare providers.
Immunomodulators
Immunomodulators suppress the immune system to prevent inflammation and
are typically combined with biologics to treat severe UC. Doctors may
prescribe these medications when symptoms don't respond to
aminosalicylates.
Examples include azathioprine (Azasan, Imuran), mercaptopurine
(Purixan), and methotrexate (Otrexup, Trexall, Rasuvo). Methotrexate can
increase the risk of stomach and intestinal problems, and a 2018 study
suggested it may not effectively help people with UC maintain remission.
In 2020, an AGA expert panel recommended using immunomodulators in
combination with biologics for moderate to severe UC when
aminosalicylates haven't worked. While the FDA hasn't approved
immunomodulators specifically for UC treatment, doctors may still
prescribe them off-label.
Biologics
Biologics are manufactured from genetically engineered proteins or other
natural substances that target specific immune system components
driving inflammation.
A 2023 research review examined five licensed biologics:
Adalimumab: Effective in both short and long-term treatment Infliximab:
Induces short-term response, remission, and mucosal healing Golimumab:
Similar to other biologics but requires more dose monitoring
Vedolizumab: Shows higher remission rates than adalimumab and costs less
Ustekinumab: The newest drug improves remission rates but requires more
research.
TNF Blockers
Anti-TNF drugs block tumor necrosis factor (TNF), an immune system
protein that triggers inflammation. These medications help people with
moderate to severe UC whose symptoms haven't improved with other
treatments.
TNF blockers include adalimumab (Humira), golimumab (Simponi), and
infliximab (Remicade). Adalimumab and golimumab are administered via
subcutaneous injection, while infliximab is given through IV infusion.
Vedolizumab (Entyvio)
Vedolizumab treats moderate to severe disease by preventing damaging
white blood cells from entering the gastrointestinal tract and causing
inflammation. Previously available only through IV infusion, the FDA
recently approved subcutaneous administration.
Choosing a Biologic
The AGA suggests that people with moderate to severe UC who are new to
biologics choose infliximab or vedolizumab rather than adalimumab, as
the former options are more effective.
However, some patients may find adalimumab more convenient since it can
be self-administered, while other biologics require healthcare
professional administration. Adalimumab is a reasonable choice if you
prefer self-injectable medication or find it more accessible or
affordable. Patients should discuss all options with their doctors.
Surgery
When medications fail to control symptoms or complications arise,
surgery may become necessary. This typically involves removing the
affected portion of the colon.
The Takeaway
Beyond currently available medications, researchers continue
investigating new and potentially improved treatments through clinical
trials. In 2023, the FDA approved a new medication for treating moderate
to severe UC in adults, expanding the therapeutic options available to
patients.
The landscape of UC treatment continues to evolve, with an increasing
number of effective medications and ongoing research promising
additional options. Working closely with healthcare providers to find
the right treatment combination—considering disease severity, previous
treatments, and individual circumstances—remains key to successfully
managing ulcerative colitis and achieving lasting remission.