From the Guidelines
For patients with ulcerative colitis, the most effective treatment approach is to use oral corticosteroids such as prednisolone 40 mg daily, weaning over 6–8 weeks, as recommended by the British Society of Gastroenterology consensus guidelines 1. This approach is supported by high-quality evidence and has a strong recommendation agreement of 100%. The treatment of colitis depends on the specific type, with ulcerative colitis being a chronic, relapsing-remitting inflammatory bowel disease characterized by diffuse mucosal inflammation of the colon 1. Some key points to consider in the treatment of colitis include:
- The use of 5-aminosalicylates like mesalamine (1-4g daily) for mild to moderate disease, often combined with topical therapy such as mesalamine enemas (4g nightly) for distal disease.
- The role of immunomodulators like azathioprine (2-3mg/kg daily) or biologics such as infliximab (5mg/kg IV at weeks 0,2,6, then every 8 weeks) for maintenance therapy.
- The importance of staying hydrated, temporarily avoiding high-fiber foods during flares, and identifying personal trigger foods. The pathogenesis of inflammatory bowel disease, which includes ulcerative colitis, is thought to involve the migration of lymphocytes from lymphoid tissues to the intestines, where they promote inflammation 1. Recent guidelines, such as those from the World Journal of Emergency Surgery, emphasize the importance of tailored therapy and the choice of treatment regimen depending on several factors, including the type, distribution, and disease severity, as well as co-morbidity and patient preferences 1.
From the FDA Drug Label
Ulcerative Colitis: • reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy. (1. 3) Pediatric Ulcerative Colitis: • reducing signs and symptoms and inducing and maintaining clinical remission in pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy. (1. 4)
Infliximab (IV) is indicated for the treatment of ulcerative colitis in adult and pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy. The goal of treatment is to reduce signs and symptoms, induce and maintain clinical remission, and eliminate corticosteroid use. 2 2 2
From the Research
Definition and Treatment of Colitis
- Colitis refers to inflammation of the colon, with ulcerative colitis (UC) being a type of inflammatory bowel disease (IBD) characterized by chronic inflammation and ulceration of the colon lining 3.
- The management of UC therapy should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome, with the goal of achieving complete remission 3.
Treatment Options for Colitis
- Mesalazine (also known as mesalamine) is a 5-aminosalicylic acid compound used in the treatment of mild to moderate ulcerative colitis, with high rates of efficacy in induction and maintenance of remission 4, 5.
- Glucocorticoids, such as prednisone, are commonly used to treat moderate to severe UC, but their use is limited by potential side effects, and alternative treatments like azathioprine or 6-mercaptopurine may be used to wean patients off glucocorticoids 6.
- Other treatment options for UC include infliximab, methotrexate, budesonide, and cyclosporine, with the choice of treatment depending on the severity of the disease and the patient's response to previous treatments 6, 7.
Patient-Centered Therapy for Colitis
- Patient-centered care for mild-to-moderate UC, such as the iSTART approach, involves patient self-assessment and self-starting of second-line treatment when necessary, with the goal of rapid resolution of flares and improved quality of life 7.
- Optimized 5-ASA is the first-line treatment for UC, but may not be sufficient to induce remission in all patients, and corticosteroids like budesonide MMX® may be prescribed as second-line therapy when needed 7.