What medication is suitable for a patient with ulcerative colitis (inflammatory bowel disease)?

From the Guidelines

For a patient with colitis, the most effective treatment is typically mesalamine (2–3 grams/d) or diazo-bonded 5-ASA, as recommended by the AGA guidelines 1.

Treatment Options

• Mesalamine is the preferred treatment for mild to moderate ulcerative colitis, with a strong recommendation from the AGA guidelines 1.
• The dose of mesalamine can be standardized to 2-3 grams per day, with the option to add rectal mesalamine for patients with suboptimal response or moderate disease activity 1.
• For patients with left-sided mild-moderate ulcerative proctosigmoiditis or proctitis, mesalamine enemas or suppositories are suggested as the first-line treatment 1.

Disease Severity and Extent

• The treatment choice depends on the specific type of colitis (ulcerative colitis vs. Crohn's disease), disease severity, extent of inflammation, and individual patient factors.
• For moderate to severe ulcerative colitis, biologic agents such as infliximab, adalimumab, or vedolizumab may be considered, with a strong recommendation from the AGA guidelines 1.

Patient Factors

• Patients should also maintain adequate hydration, consider dietary modifications (low-residue diet during flares), and have regular follow-up appointments to monitor disease activity and medication side effects.
• The treatment plan should be individualized based on patient preferences, disease severity, and response to treatment, with a focus on minimizing morbidity, mortality, and improving quality of life.

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.
2. 4 Pediatric Ulcerative Colitis RENFLEXIS is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in pediatric patients 6 years of age and older with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.
3. 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.
4. 4 Pediatric Ulcerative Colitis The recommended dose of RENFLEXIS for pediatric patients 6 years and older 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 medicine for a patient with colitis is infliximab (IV), specifically RENFLEXIS. The recommended dose for adult patients with 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 2. For pediatric patients 6 years and older with ulcerative colitis, the recommended dose is also 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:

• Indication: Reducing signs and symptoms, inducing and maintaining clinical remission, and mucosal healing in patients with ulcerative colitis.
• Dose: 5 mg/kg for both adult and pediatric patients.
• Administration: Intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen every 8 weeks.

From the Research

Treatment Options for Colitis

• 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 ulcerative colitis (UC) 3, 4, 5.
• 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 3.
• The various formulations of mesalamine available are primarily differentiated by the methods of delivery of the active compound of the drug to the colon 3.

Dosage and Administration

• Mesalamine with Multi-Matrix System(®) (MMX) technology is an oral (1.2 g), once-daily tablet formulation of mesalamine used for the treatment of UC 3.
• In clinical studies, MMX mesalamine (taken as a once-daily dose of 2.4 or 4.8 g) effectively induced and maintained clinical remission in patients with active mild-to-moderate UC 3.
• Dose-ranging studies of mesalazine formulations for induction of remission have demonstrated increased efficacy of oral mesalazine up to 4-4.8 g/day, particularly in patients with more moderate disease activity 6.

Combination Therapy

• Combination therapy with oral and rectal mesalazine provides additional efficacy for patients with both distal and extensive colitis 6.
• The addition of mesalamine to corticosteroids during hospitalization for acute severe ulcerative colitis (ASUC) did not show significant benefits compared to corticosteroids alone, although there was a numerical reduction in the need for biologics at 90 days in the mesalamine group 7.