From the Guidelines
Ulcerative colitis (UC) is characterized by symptoms including bloody diarrhea, abdominal pain, urgency to defecate, tenesmus (feeling of incomplete evacuation), fatigue, weight loss, and fever during flares, and treatment should prioritize comprehensive disease control, incorporating patient-centric measures and biomarker-based monitoring strategies, as recommended by recent guidelines 1.
Symptoms of Ulcerative Colitis
The symptoms of UC can vary in severity and may include:
- Bloody diarrhea
- Abdominal pain
- Urgency to defecate
- Tenesmus (feeling of incomplete evacuation)
- Fatigue
- Weight loss
- Fever during flares
Treatment Options for Ulcerative Colitis
Treatment depends on disease severity and location. For mild to moderate UC, first-line therapy typically includes:
- 5-aminosalicylates (5-ASAs) such as mesalamine (doses ranging from 2.4-4.8g daily orally for induction, then maintenance) 1
- Topical therapies like mesalamine suppositories (1g daily) or enemas (4g daily) for distal disease
- Corticosteroids like prednisone (40mg daily, tapered over 8-12 weeks) for moderate-severe flares, but not suitable for long-term use due to side effects
- Immunomodulators such as azathioprine (2-3mg/kg/day) or 6-mercaptopurine (1-1.5mg/kg/day) for steroid-dependent or refractory cases
- Biologic therapies including anti-TNF agents (infliximab, adalimumab, golimumab), anti-integrin therapies (vedolizumab), and JAK inhibitors (tofacitinib) for moderate-severe disease 1
Comprehensive Disease Control and Biomarker-Based Monitoring
Recent guidelines recommend a patient-centric approach to treatment, incorporating comprehensive disease control and biomarker-based monitoring strategies 1. This includes:
- Using fecal calprotectin, fecal lactoferrin, and CRP to inform treatment decisions and monitor disease activity 1
- Incorporating patient-reported symptoms, such as bowel urgency, abdominal pain, and fatigue, into treatment decisions 1
- Prioritizing endoscopic remission, histological healing, and normalization of inflammatory biomarkers as treatment targets 1
Lifestyle Modifications and Surveillance
Patients with UC should maintain regular follow-up with gastroenterologists, undergo surveillance colonoscopies due to increased colorectal cancer risk, and consider lifestyle modifications including:
- Stress management
- Dietary adjustments
- Avoiding triggers that can exacerbate symptoms
By prioritizing comprehensive disease control, biomarker-based monitoring, and patient-centric care, patients with UC can achieve optimal outcomes and improve their quality of life 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. The symptoms of Ulcerative Colitis (UC) are not explicitly listed in the drug label, but the label does indicate that RENFLEXIS is used to reduce signs and symptoms of the disease. The treatment options for UC include RENFLEXIS, which is used to reduce signs and symptoms, induce and maintain clinical remission and mucosal healing, and eliminate corticosteroid use in adult patients with moderately to severely active UC who have had an inadequate response to conventional therapy 2.
- Key points about treatment:
- RENFLEXIS is administered as an intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks.
- The recommended dose of RENFLEXIS for adult patients with moderately to severely active UC is 5 mg/kg 2.
From the Research
Symptoms of Ulcerative Colitis
- Bloody diarrhea with or without mucus 3, 4, 5
- Rectal urgency 3, 5
- Tenesmus 3, 5
- Variable degrees of abdominal pain that is often relieved by defecation 3
- Fecal urgency 5
- Extraintestinal manifestations may predate the onset of gastrointestinal symptoms 5
Diagnosis of Ulcerative Colitis
- Combination of clinical presentation, endoscopic findings, histology, and the absence of alternative diagnoses 3
- Ileocolonoscopy with biopsy is the only way to make a definitive diagnosis of UC 3
- Pathognomonic finding of UC is the presence of continuous colonic inflammation characterized by erythema, loss of normal vascular pattern, granularity, erosions, friability, bleeding, and ulcerations, with distinct demarcation between inflamed and non-inflamed bowel 3
- Histopathology is the definitive tool in diagnosing UC, assessing the disease severity and identifying intraepithelial neoplasia (dysplasia) or cancer 3
Treatment Options for Ulcerative Colitis
- Topical 5-aminosalicylic acid (5-ASA) drugs for proctitis 3
- Combination of oral and topical 5-ASA drugs +/- corticosteroids to induce remission for more extensive or severe disease 3
- Intravenous steroids and if refractory, calcineurin inhibitors (cyclosporine, tacrolimus) or tumor necrosis factor-α antibodies (infliximab) for severe UC 3
- Mesalamine is a 5-aminosalicylic acid compound that is the first-line therapy to induce and maintain clinical remission in patients with mild-to-moderate UC 4, 6
- Azathioprine and mercaptopurine are effective in reducing either the need for corticosteroids or clinical relapses, and for long term maintenance remission 7
- Cyclosporin may be useful in inducing remission in patients with acutely severe disease who do not achieve remission with an intensive intravenous regimen 7
Maintenance of Remission
- Oral and rectal 5-aminosalycilates are typically used for mild to moderate UC 5
- Thiopurines, biological agents targeting tumor necrosis factor and integrins, and the small-molecule Janus kinase inhibitors may be used for moderate to severe colitis 5
- Mesalamine has been demonstrated in randomized controlled trials to maintain clinical remission in patients with UC 6