From the Guidelines
Common treatments for mild to moderate ulcerative colitis include 5-aminosalicylates (5-ASAs) as first-line therapy, with mesalamine being a preferred option at doses of 2-3 grams/day. Medications such as mesalamine (Asacol, Lialda, Pentasa) work by reducing inflammation in the colon lining and can be administered orally or rectally depending on disease location 1. For distal colitis, topical therapy with mesalamine suppositories (1g daily) or enemas (4g daily) is often effective.
Key Treatment Considerations
- Oral mesalamine is recommended over low-dose mesalamine, sulfasalazine, or no treatment for extensive mild-moderate ulcerative colitis 1.
- Rectal mesalamine can be added to oral 5-ASA for patients with extensive mild-moderate ulcerative colitis 1.
- High-dose mesalamine (>3gm/d) with rectal mesalamine may be considered for patients with moderate disease activity or suboptimal response to standard-dose mesalamine 1.
- Once-daily dosing with mesalamine is as effective as divided doses 1.
- Corticosteroids like prednisone may be added for flare-ups but aren't recommended for long-term use due to side effects.
Additional Therapies
- Probiotics and dietary modifications (low-residue diet during flares, adequate hydration) can complement medical therapy, although their effectiveness is still being studied 1.
- If symptoms persist despite these treatments, immunomodulators like azathioprine or biologics may be considered.
- Regular follow-up with a gastroenterologist is essential to monitor disease activity and medication effectiveness, with treatment adjustments made based on symptom control and endoscopic findings.
From the FDA Drug Label
The safety and effectiveness of mesalamine has been established for the treatment of mildly to moderately active ulcerative colitis in pediatric patients weighing at least 24 kg Use of mesalamine in this population is supported by evidence from adequate and well-controlled trials in adults, a multicenter, randomized, double-blind, parallel group trial in 105 pediatric patients 5 to 17 years of age, and additional pharmacokinetic analyses.
Common treatments for mild to moderate ulcerative colitis include mesalamine, as it has been established as safe and effective for this condition in patients weighing at least 24 kg 2.
- Key points:
- Mesalamine is used for mildly to moderately active ulcerative colitis
- Established safety and effectiveness in pediatric patients weighing at least 24 kg
- Supported by evidence from adequate and well-controlled trials in adults and pediatric patients 2
From the Research
Common Treatments for Colitis
- The cornerstone of treatment for mild ulcerative colitis is the oral or topical (rectal) application of aminosalicylates (5-ASA) 3, 4, 5, 6.
- 5-ASA preparations are often only administered orally in mild ulcerative colitis, but rectal 5-ASA preparations are even more effective than oral administration in ulcerative proctitis and left-sided colitis 3, 6.
- Topical steroids such as budesonide are also used in mild Crohn's disease and ulcerative colitis 3.
- For acute treatment of mild to moderate flares and in maintenance treatment, aminosalicylates have established efficacy 4.
- The dosage forms available for rectal delivery include suppositories, foams, and liquid enemas, and selection among these preparations should be guided by the proximal extent of disease and patient preference 6.
Treatment Options for Mild to Moderate Ulcerative Colitis
- Oral 5-ASA is safe in maintenance treatment and is generally well tolerated 4.
- Rectal 5-ASA is superior to placebo and to conventional rectal corticosteroids in inducing remission of distal ulcerative colitis 6.
- The combination of rectal 5-ASA with a rectal corticosteroid or oral aminosalicylate is superior to rectal 5-ASA alone 6.
- Immunosuppressive agents such as 6-mercaptopurine, azathioprine, cyclosporin, and tacrolimus are effective for severe active UC, but have side effects and are not suitable for all patients 7.