What is the treatment for colitis (inflammation of the colon)?

From the Guidelines

For mild to moderately active extensive ulcerative colitis, treatment should initially involve an aminosalicylate enema 1 g/day combined with oral mesalamine ≥ 2.4 g/day, as this approach has been shown to be effective in managing symptoms and inducing remission 1.

Key Considerations

• The choice of treatment should be based on the severity and extent of the disease, as well as patient factors such as comorbidities and preferences.
• For moderate to severe ulcerative colitis, oral corticosteroids such as prednisolone 40 mg daily, weaning over 6–8 weeks, are recommended as they have been shown to be effective in reducing inflammation and managing symptoms 1.
• In cases of severe active ulcerative colitis, initial treatment with intravenous steroids, such as methylprednisolone 60 mg each 24 h or hydrocortisone 100 mg four times daily, is recommended, with consideration of monotherapy with intravenous ciclosporin as an alternative, especially in cases of serious adverse events due to steroids 1.
• Maintenance therapy with aminosalicylates, azathioprine, or mercaptopurine should be considered to reduce the risk of relapse in patients with ulcerative colitis 1.

Treatment Options

• Aminosalicylic acid (5-ASA) medications like mesalamine (1-4g daily) are often the first-line treatment for mild to moderate ulcerative colitis.
• Corticosteroids such as prednisone (40-60mg daily, tapered over 8-12 weeks) may be used for moderate to severe flares but aren't recommended for long-term use due to side effects.
• Immunomodulators like azathioprine (2-3mg/kg/day) or biologics such as infliximab (5mg/kg at weeks 0,2, and 6, then every 8 weeks) or adalimumab may be necessary for patients who don't respond to initial treatments.
• Lifestyle modifications, including a low-residue diet during flares, adequate hydration, and stress management, are important supportive measures.

Monitoring and Surgical Options

• Regular monitoring of symptoms and medication side effects is essential.
• Surgical options like colectomy may be considered for severe cases unresponsive to medical therapy or complications like toxic megacolon.

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. The treatment for ulcerative colitis (a type of colitis) is infliximab (IV), which 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.

• The recommended dose of infliximab 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.
• Key points:
  • Infliximab is used to treat ulcerative colitis.
  • It is given intravenously.
  • The dose is 5 mg/kg.
  • It is given every 8 weeks after the initial induction regimen.

From the Research

Treatment Options for Colitis

The treatment for colitis, specifically ulcerative colitis (UC), depends on the severity and extent of the inflammation. The primary goal of treatment is to induce and maintain remission of symptoms and mucosal inflammation.

• For mild-to-moderate UC, topical treatment with 5-aminosalicylic acid (5-ASA) is the treatment of choice, as shown in studies 3, 4, 5.
• Oral aminosalicylates are effective in both distal and extensive mild-to-moderate disease, but in distal disease, the rates of remission are lower than those obtained with topical 5-ASA 3.
• New steroids, such as budesonide and beclomethasone dipropionate (BDP), administered as enemas, constitute an alternative to 5-ASA therapy 3.
• Patients with unresponsive disease or those with more severe presentation will require oral corticosteroids and sometimes intravenous therapy 3, 6.
• Advanced therapies, including anti-TNF, anti-integrin, and anti-IL12/23 agents, as well as JAK inhibitors and sphingosine1-phosphate receptor modulators, are now frequently used for patients with more severe UC 7.

Maintenance of Remission

• Oral aminosalicylates are the first-line therapy in maintenance of remission 3, 5.
• Topical 5-ASA may play a role in distal disease 3, 5.
• Patients who are steroid dependent can be started on azathioprine or 6-mercaptopurine, although it may take up to 3 months for the treatment to become effective 3.
• Mesalamine (5-ASA) is a first-line treatment for patients with mild-to-moderate UC and has been demonstrated to induce and maintain clinical remission 4.

Severe Disease

• Patients with severe disease should be managed jointly by a medical and surgical team, and intensive intravenous treatment should be started with high-dose steroids 3, 6.
• Early recognition of failure of therapy will allow the introduction of immunosuppressive therapy with intravenous cyclosporine 3.
• Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding 6.