From the Guidelines
The treatment for colitis typically involves a combination of medications and lifestyle changes, with the approach depending on the severity and underlying cause of the condition.
Treatment Options
- Mild to Moderate Colitis: Aminosalicylates such as mesalamine (Asacol, Pentasa) at a dose of 2.4 to 4.8 grams per day, divided into 2-3 doses, for 6-8 weeks, are often used to treat mild to moderate colitis 1. In some cases, sulfasalazine (Azulfidine) at a dose of 500 mg to 1 gram, 4 times a day, may be used.
- Moderate to Severe Colitis: Corticosteroids like prednisone at a dose of 40-60 mg per day may be prescribed for a short term, typically 2-3 months, to induce remission 1. Immunomodulators such as azathioprine (Imuran) at a dose of 2-2.5 mg/kg per day or mercaptopurine (Purinethol) at a dose of 1-1.5 mg/kg per day may be added for maintenance therapy.
- Biologics: Biologics like infliximab (Remicade) at a dose of 5 mg/kg at weeks 0,2, and 6, and then every 8 weeks, or adalimumab (Humira) at a dose of 160 mg at week 0 and 80 mg at week 2, and then 40 mg every other week, may be considered for patients who do not respond to other treatments.
- Maintenance Therapy: For patients with recurrence of symptoms following discontinuation of induction therapy, budesonide at a dose of 6 mg daily may be recommended for maintenance of clinical remission 1.
Key Considerations
- The management of colitis should be individualized based on the patient's specific condition, medical history, and response to therapy.
- It's essential to work closely with a healthcare provider to determine the best treatment plan.
- The use of probiotics, helminth therapy, and other alternative therapies may not be recommended due to insufficient evidence or potential risks 1.
From the FDA Drug Label
3 Ulcerative Colitis RENFLEXIS is indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.
3 Ulcerative Colitis The recommended dose of RENFLEXIS is 5 mg/kg given as an intravenous induction regimen at 0,2 and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter for the treatment of adult patients with moderately to severely active ulcerative colitis.
The treatment for ulcerative colitis is Infliximab (RENFLEXIS), which is administered as an intravenous induction regimen at a dose of 5 mg/kg at weeks 0,2, and 6, followed by a maintenance regimen of 5 mg/kg every 8 weeks. 2
- Key points:
- Indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use.
- Recommended dose: 5 mg/kg intravenous induction regimen at 0,2, and 6 weeks, followed by 5 mg/kg every 8 weeks.
- For adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.
From the Research
Treatment Options for Colitis
The treatment for colitis, specifically ulcerative colitis (UC), depends on the severity and extent of the disease. According to 3, mild-to-moderate UC can be managed with:
- Aminosalicylates
- Mesalamine
- Topical corticosteroids
- Oral corticosteroids reserved for unresponsive cases
Moderate-to-Severe UC Treatment
For moderate-to-severe UC, treatment options include:
- Oral or intravenous corticosteroids in the short-term
- Biologic agents (as initial therapy or in transition from steroids)
- Thiopurines (as bridging therapy) 3, 4
Severe or Fulminant UC Treatment
Patients with severe or fulminant UC who are recalcitrant to medical therapy or develop disease complications may require:
- Colectomy, which can be a life-saving procedure 3
- Early surgical referral is crucial in these cases
Emerging Therapeutic Approaches
Recent studies have explored emerging therapeutic approaches, including:
- Novel formulations of traditional therapeutic agents such as 5-aminosalicylates and corticosteroids
- New chemical entities and biologic agents targeting specific mechanisms involved in the inflammatory cascade for UC 5
- Alternative therapies such as probiotics, nicotine, and fish oil 6
Clinical Guidelines and Recommendations
Clinical guidelines and recommendations for the treatment of UC have been updated to reflect new evidence and approaches, including the use of the GRADE approach to develop guidelines 7. These guidelines provide recommendations for induction and maintenance therapy in severe and mild-moderate flare-ups, as well as algorithms for practical decision-making.