What is the treatment for pancolitis (ulcerative colitis involving the entire colon)?

From the Guidelines

Pancolitis treatment should prioritize the use of oral mesalamine ≥ 2.4 g/day, as it is the most effective first-line therapy for mild to moderately active extensive ulcerative colitis, according to the most recent and highest quality study 1. The treatment of pancolitis typically involves a combination of medications to reduce inflammation and manage symptoms.

• For mild to moderate cases, 5-aminosalicylates (5-ASAs) like mesalamine are the first-line therapy, often administered orally and sometimes with rectal formulations for comprehensive coverage.
• Corticosteroids such as prednisone are used for moderate to severe flares to quickly reduce inflammation, with a recommended dose of 40 mg daily, tapered over 8 weeks 1.
• For maintenance therapy, immunomodulators like azathioprine or 6-mercaptopurine help prevent relapses and reduce steroid dependency, with recommended doses of 1.5-2.5 mg/kg/day and 0.75-1.5 mg/kg/day, respectively 1.
• In severe or refractory cases, biological agents such as infliximab, adalimumab, or vedolizumab target specific inflammatory pathways, with recommended doses and administration schedules varying depending on the agent and patient response. The goal of treatment is to achieve clinical remission, promote mucosal healing, prevent complications, and improve quality of life, with individualized treatment plans based on disease severity, previous medication response, and patient preferences 1. Some patients may also benefit from the use of small molecule therapies, such as ozanimod, which has been shown to be effective in the treatment of ulcerative colitis 1. Regular follow-up with colonoscopies is important to assess mucosal healing and disease activity, and patients should be monitored for nutritional deficiencies, particularly iron, folate, and vitamin B12, and receive appropriate supplementation 1.

From the FDA Drug Label

1. 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.

2. 4 Pediatric Ulcerative Colitis RENFLEXIS is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in pediatric patients 6 years of age and older with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.

3. 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.

4. 4 Pediatric Ulcerative Colitis The recommended dose of RENFLEXIS for pediatric patients 6 years and older with moderately to severely active ulcerative colitis 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.

Pancolitis Treatment:

• Infliximab (IV) is indicated for the treatment of moderately to severely active ulcerative colitis, which includes pancolitis.
• The recommended dose for adult patients with moderately to severely active ulcerative colitis 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.
• For pediatric patients 6 years and older with moderately to severely active ulcerative colitis, the recommended dose 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 2.

Key Points:

• Infliximab (IV) is used to reduce signs and symptoms, induce and maintain clinical remission, and eliminate corticosteroid use in patients with moderately to severely active ulcerative colitis.
• The treatment regimen for infliximab (IV) includes an induction phase and a maintenance phase.
• Pediatric patients 6 years and older can be treated with infliximab (IV) for moderately to severely active ulcerative colitis.

From the Research

Treatment Options for Pancolitis

• The treatment of pancolitis, a condition where ulcerative colitis affects the entire colon, is a complex process that requires careful consideration of various factors, including the severity and extent of the inflammation 3.
• According to a study published in 2003, oral aminosalicylates are effective in treating extensive mild-to-moderate ulcerative colitis, but may not be as effective as topical 5-aminosalicylic acid (5-ASA) in distal disease 4.
• Another study published in 2012 summarized the current guidelines for first-line treatments in inflammatory bowel disease, including pancolitis, and recommended the use of 5-aminosalicylates, budesonide, systemic steroids, azathioprine, and other medications depending on the severity of the disease 5.
• Mesalamine is considered a first-line therapy for ulcerative colitis, including pancolitis, and has been shown to be effective in inducing and maintaining remission in patients with mild to moderate disease 6.
• A recent update of clinical practice guidelines for the treatment of ulcerative colitis in adults recommends the use of budesonide MMX as an option when treatment with 5-ASA fails, and before using systemic steroids, and suggests that infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy in moderate-to-severe UC 7.

Medications Used in Pancolitis Treatment

• 5-aminosalicylic acid (5-ASA) 4
• Oral aminosalicylates 4, 5
• Budesonide 4, 5, 7
• Systemic steroids 4, 5
• Azathioprine 4, 5
• Infliximab 5, 7
• Adalimumab 5, 7
• Vedolizumab 7
• Ustekinumab 7
• Tofacitinib 7
• Mesalamine 6