From the Guidelines
For the treatment of colitis, particularly ulcerative colitis, the most effective approach typically involves a combination of medications, lifestyle changes, and sometimes surgery, depending on the severity and type of colitis. The primary goal is to reduce inflammation, manage symptoms, and induce and maintain remission, thereby improving quality of life and reducing morbidity and mortality. Key considerations in treatment include:
- For mild to moderate ulcerative colitis, aminosalicylates like mesalamine (1-4g daily) are often the first-line treatment, working by reducing inflammation in the colon 1, 2.
- Corticosteroids such as prednisone (40-60mg daily, tapered over 8-12 weeks) may be used for moderate to severe flares to quickly reduce inflammation, but aren't suitable for long-term use due to side effects 3, 4.
- For maintenance therapy, immunomodulators like azathioprine (1.5-2.5mg/kg daily) or 6-mercaptopurine (1-1.5mg/kg daily) can help maintain remission 5.
- Biologic agents such as infliximab (5mg/kg IV at weeks 0, 2, and 6, then every 8 weeks) or adalimumab (160mg initially, 80mg at week 2, then 40mg every other week) are effective for moderate to severe disease that doesn't respond to other treatments.
- Dietary modifications, including avoiding trigger foods and increasing fluid intake, can help manage symptoms.
- Probiotics may benefit some patients by promoting healthy gut bacteria.
- Surgery becomes necessary in cases of severe colitis unresponsive to medical therapy, perforation, or when there's a high risk of colorectal cancer. Given the most recent evidence, the use of small molecule therapies like ozanimod for the treatment of ulcerative colitis offers advantages, including oral administration and little to no risk of immunogenicity 6. Treatment should be individualized based on disease location, severity, and patient factors, with regular monitoring to assess response and adjust therapy as needed.
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.
- 3 Ulcerative Colitis The recommended dose of RENFLEXIS 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 thereafter for the treatment of adult patients with moderately to severely active ulcerative colitis.
Infliximab (IV) is used to treat ulcerative colitis. The recommended dose for adult patients with moderately to severely active ulcerative colitis 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. The goal of treatment is to reduce signs and symptoms, induce and maintain clinical remission and mucosal healing, and eliminate corticosteroid use in patients who have had an inadequate response to conventional therapy 7.
From the Research
Colitis Treatment Overview
- Ulcerative colitis (UC) is a chronic inflammatory disease of the colon that typically manifests as diarrhea, abdominal pain, and bloody stool 8.
- The goals of management are to induce and maintain clinical remission and to screen for complications of this disease 8.
Treatment Options
- 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 8, 9.
- For patients who are refractory to mesalamine or have more severe disease, steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab may be used to induce and/or maintain remission 8.
- Anti-tumor necrosis factor (TNF) agents, such as adalimumab and golimumab, are effective in induction of remission and maintenance of remission in patients with extensive ulcerative colitis 10.
Mesalamine Formulations
- There are multiple formulations of mesalamine available, primarily differentiated by their means of delivering active mesalamine to the colon 9.
- Mesalamine with Multi-Matrix System (MMX) technology is an oral, once-daily tablet formulation of mesalamine used for the treatment of UC 8.
- Once-daily dosing with multi-matrix system mesalamine 1.2 g tablets may lead to optimal compliance 11.
Dose Response and Chemoprevention
- For induction therapy, it is unclear if there is a dose response above 1.5 g, and for maintenance therapy, existing data do not support a dose response above 1.5 g 11.
- Mesalamine >/= 1.2 g and sulfasalazine >/= 2 g reduce the risk of colorectal cancer in patients with ulcerative colitis 11.
- The maximum dose of 5-aminosalicylate is necessary for patients with risk factors for recurrence or hospitalization 12.