Treatment of Ulcerative Colitis

Wojciech Blonski; Anna M. Buchner; Gary R. Lichtenstein

Disclosures

Curr Opin Gastroenterol. 2014;30(1):84-96. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Ulcerative colitis is a chronic inflammatory disease of the colon of unknown cause that is characterized by alternating intervals of active and inactive disease in 80–90% of patients. The primary goal of treatment is to induce and maintain remission using therapy tailored to the individual patient. The purpose of this review was to describe the management of ulcerative colitis with emphasis on the use of anti-tumor necrosis factor (TNF) agents.

Recent findings: Recent research has shown that new anti-TNF agents, adalimumab (ADA) and golimumab, are effective in induction of remission and maintenance of remission in patients with extensive ulcerative colitis. In a recent study, infliximab was found to have comparable efficacy to cyclosporine in treatment of acute severe refractory to corticosteroids ulcerative colitis.

Summary: Anti-TNF therapy should be initiated in patients with acute severe refractory to corticosteroids ulcerative colitis and in patients with moderate-to-severe ulcerative colitis who are not responsive to conventional treatment with aminosalicylates, corticosteroids and immune modulators. Alternatives to infliximab are ADA and golimumab. Future research is needed to further assess the long-term efficacy and safety of ADA and golimumab in ulcerative colitis.

Introduction

Ulcerative colitis is classically characterized by alternating stages of clinically active and inactive disease; a pattern seen in 80–90% of patients.[1,2] According to population-based studies, an intermittent course of the disease occurs in 40–65% of patients after the first disease flare, whereas a continuous course of active disease may be seen in 5–10% of patients.[3,4] Moreover, an analysis of 1161 patients with ulcerative colitis participating in a large population-based cohort study in Scandinavia showed that at the time of initial presentation of the disease, 71% of patients had moderate ulcerative colitis, 20% had mild ulcerative colitis and 9% had severe ulcerative colitis.[5] After 25 years, the cumulative probability of an intermittent disease course of ulcerative colitis was 90%.[2] The colectomy rates were 20 and 30% within 10 and 25 years of disease duration, respectively The treatment of ulcerative colitis is sequential and tailored to the individual patient, as there is no one universally effective medication. Available options include aminosalicylates, corticosteroids, immunosuppressive medications such as azathioprine, 6-mercaptopurine and antitumor necrosis factor α (TNF-α) antibodies.

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