Ulcerative colitis (UC) & Drugs/Treatments

What forms of therapeutic management of ulcerative colitis need to be distinguished?

Induction therapy for active UC and maintenance therapy for UC in remission

The treatment goal is to heal the mucosa; achieving long-term remission is a key objective, successful treatment reduces hospital stays, avoiding bowel resection is a desired outcome (1).

Conventional Mayo endoscopic score (MES) is more effective than segmental Mayo endoscopic score (MES) for identifying treatment effects. Further research is recommended to investigate different endoscopic scoring methods (2).

The healing process for Ulcerative colitis (UC) progresses from proximal to distal areas (2)

Current Therapy for Ulcerative Colitis covers:

• 5-Aminosalicylic Acid Drugs: Utilized in treatment for induction of remission and for maintenance of mild to moderate ulcerative colitis (UC) (16, 17, 19, 20)


• Corticosteroids: Commonly prescribed for patients with moderate to severe ulcerative colitis (UC), systemic corticosteroids are the first-line induction therapy; for patients who do not respond to or cannot tolerate 5-ASA medications (9, 16, 17, 18)


• Immunosuppressants: Part of the therapeutic regimen (21, 22).

Theseare the primary drugs used for treating Ulcerative Colitis (UC). Examples of immunosuppressants include thiopurines (for maintenance), methotrexate, and 6-mercaptopurine. However, current treatments for UC are often ineffective (3). Thiopurines are used for patients with ulcerative colitis (UC) who do not respond to steroids or are dependent on them (14, 15).

Moreover (3, 8):

• Biologic Agents: Included in treatment options.
  
  
  • Anti-cytokines
  
  
  • Anti-integrins / Integrin inhibitors
  
  
  • Janus kinase inhibitors
  
  
  • Sphingosine-1-phosphate receptor modulators
  
  
  
  

The treatment options for gastroenterologists managing ulcerative colitis (UC) have expanded significantly.
This growth began with the introduction of monoclonal antibodies targeting Tumor Necrosis Factor alfa (TNF-alfa) (5).

Evidence indicates that Janus Family Kinases (JAKs) and Sphingosine-1 phosphate receptor 1 are therapeutic targets in UC (7).

Moreover:

• Complementary and Alternative Medication: Also considered in therapy.


• Traditional Chinese Medicine (TCM): Widely applied in UC therapy.

Complementary and alternative medicines, especially herbal medicines, are being used more frequently in the treatment of ulcerative colitis. These treatments are considered due to their potential effects on regulating gut microbiota in patients (10, 11, 12)

The progression of the disease in most UC patients can be effectively managed with outpatient medications (13).

Despite the availability of these treatments, 10-20% of patients may still need a proctocolectomy due to medically refractory disease (4, 24). The surgery often involves a colectomy. This procedure typically occurs within 20 years of diagnosis. A colectomy involves removing a significant portion of the colon (24)

Up to 50% of ulcerative colitis (UC) patients do not respond to initial treatment or lose response over time (6, 7, 23).

References

(1) Oka et al. 2024 Science 14: 1653
(2) Wong et al. 2026 Inflammatory Bowel Diseases 32(1): 87-96
(3) Wangchuk et al. 2024 Trends in Pharmacological Sciences 45(10): 892-903#
(4) Le Berre et al. 2023 Lancet 402: 571-584
(5) Grova et al. 2023 Immunotherapy 15: 1539-1552
(6) Hanzel et al. 2023 Immunotherapy 15: 1199–1208
(7) Salvatori et al. 2023 Expert Opinion on Emerging Drugs 28(3): 191-201
(8) Feng et al. 2022a Evidence-Based Complementary and Alternative Medicine 2022 doi.org/10.1155/2022/8075344
(9) Hu et al. 2021c Front. Med. 8: 766126
(10) Naganuma et al. 2018 Gastroenterology 154(4): 935-947
(11) Liu et al. 2020 Front. Pharmacol.11: 1036
(12) Zou et al. 2020 Appl. Microbiol. Biotechnol. 104(13): 5999-6012
(13) Kobayashi et al. 2020 Nat Rev Dis Primers 6: 74
(14) Harbord et al. 2017 J Crohns Colitis 11: 769-84
(15) Ko et al. 2019 Gastroenterology 156: 748-64
(16) Sandborn et al. 2012 Gastroenterology 143: 1218-26
(17) Ungaro et al. 2017 Lancet 389: 1756-70
(18) Rhen & Cidlowski 2005 N. Engl. J. Med. 353: 1711–1723
(19) Nugent et al. 2001 Gut 48: 571–577
(20) Habens et al. 2005 Apoptosis 10: 481–491
(21) Van Dieren et al. 2006 Inflamm. Bowel Dis. 12: 311–327
(22) Willot et al. 2011 Inflamm. Bowel Dis. 17: 2521–2526
(23) Mallon et al. 2007 Cochrane Database Syst Rev doi: 10.1002/14651858.CD005573.pub2.
(24) Monstad et al. 2021 J Crohns Colitis 15: 969-979

see also:
Anti-integrins / Integrin inhibitors & Inflammatory Bowel Disease (IBD)
Anti-Tumor Necrosis Factor alfa (TNF-alfa) antibodies / Tumor Necrosis Factor alfa (TNF-alfa) inhibitors & Ulcerative colitis (UC)
Inflammatory Bowel Disease (IBD) & Drugs/Treatments
Janus family kinases inhibitors (JAKis) & Ulcerative Colitis (UC)
Sphingosine-1-phosphate (S1P) receptor modulators & Ulcerative colitis (UC)