From the Guidelines
The most effective treatment option for managing colitis is the use of biologic agents such as infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab, as recommended by the AGA Clinical Guidelines Committee 1. When considering treatment options for colitis, it's essential to prioritize the severity of the condition and the patient's response to previous treatments.
Treatment Options
- For adult outpatients with moderate to severe ulcerative colitis, biologic agents are recommended over no treatment, with a strong strength of recommendation and moderate quality of evidence 1.
- The choice of biologic agent depends on various factors, including the patient's previous exposure to biologic agents and their response to treatment.
- In patients who are naïve to biologic agents, infliximab or vedolizumab may be preferred for induction of remission, although adalimumab can be considered for patients who value the convenience of self-administered subcutaneous injection 1.
Lifestyle Modifications
- In addition to medication, lifestyle modifications such as dietary changes and stress management can help alleviate symptoms and improve quality of life.
- A low-residue diet during flares and identifying trigger foods can help manage symptoms.
Surgical Interventions
- In severe cases unresponsive to medical therapy, surgical interventions such as colectomy may be necessary.
- The decision to proceed with surgery should be made on a case-by-case basis, taking into account the patient's overall health and the severity of their condition. Overall, the treatment approach for colitis should focus on reducing inflammation, managing symptoms, and improving quality of life, with the goal of achieving and maintaining remission.
Key Considerations
- The AGA Clinical Guidelines Committee recommends against using thiopurine monotherapy for induction of remission in adult outpatients with active moderate to severe ulcerative colitis 1.
- The committee also suggests against using methotrexate monotherapy for induction or maintenance of remission in adult outpatients with moderate to severe ulcerative colitis 1. By prioritizing the use of biologic agents and considering individual patient factors, healthcare providers can develop effective treatment plans for managing colitis and improving patient outcomes.
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)
Ulcerative Colitis: • 5 mg/kg at 0,2 and 6 weeks, then every 8 weeks. (2.3)
Pediatric Ulcerative Colitis: • 5 mg/kg at 0,2 and 6 weeks, then every 8 weeks. (2. 4)
The treatment options for managing colitis include infliximab (IV) at a dose of 5 mg/kg administered at 0,2, and 6 weeks, then every 8 weeks for both adult and pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy 2. The goal of treatment is to reduce signs and symptoms, induce and maintain clinical remission, and eliminate corticosteroid use.
From the Research
Treatment Options for Colitis
The treatment options for managing colitis include:
- Aminosalicylates, such as mesalazine (mesalamine), which are used for the induction and maintenance of remission in mild to moderate disease 3, 4
- Corticosteroids, which are used for the induction of remission in mild to moderate disease, but have no place in the maintenance of remission 3
- Topical treatment with mesalazine (mesalamine) for distal disease 3
- Novel therapeutic approaches, such as epidermal growth factor, RDP 58, basiliximab, and leucocytapheresis, which are being developed for the treatment of ulcerative colitis 3
- Infliximab, which has been shown to be effective in treating severe ulcerative colitis refractory to conventional therapy 5
- Azathioprine, which is used for patients who have had a severe relapse of ulcerative colitis, those with early relapse after steroids, and those needing a second course of steroids within a year 3
Severe Colitis
Severe colitis is defined as a bloody stool frequency of more than six per day with any one of tachycardia, temperature, anaemia, or raised erythrocyte sedimentation rate, and is an indication for intensive intravenous treatment 3.
- Colectomy may be necessary in some cases, and national UK figures indicate that 30% of ulcerative colitis cases progress to colectomy 3
Maintenance of Remission
The maintenance of remission is an important aspect of colitis management, and aminosalicylates continue to be first-line therapy for this purpose 3, 4.