From the Guidelines
The most effective treatment for colitis with severe diarrhea is the use of biologics such as infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab, as recommended by the AGA guidelines 1. For ulcerative colitis or Crohn's disease, the treatment approach typically involves a combination of anti-inflammatory medications, immunosuppressants, and supportive care.
- For mild to moderate disease, 5-aminosalicylates like mesalamine (1-4g daily) are often first-line treatments.
- For more severe cases, corticosteroids such as prednisone (40-60mg daily, tapered over 8-12 weeks) or budesonide (9mg daily) may be used for short-term symptom control.
- Immunomodulators like azathioprine (2-3mg/kg/day) or biologics such as infliximab (5mg/kg IV at weeks 0,2, and 6, then every 8 weeks) may be necessary for maintenance therapy in moderate to severe disease.
- Symptomatic management of severe diarrhea includes fluid and electrolyte replacement, with oral rehydration solutions or IV fluids if needed.
- Antidiarrheal medications like loperamide (4mg initially, then 2mg after each loose stool, maximum 16mg/day) can help reduce stool frequency but should be used cautiously in infectious or severe inflammatory colitis.
- Dietary modifications, including a low-residue diet during flares and adequate nutrition, are important supportive measures. The AGA guidelines recommend using biologics over no treatment for the induction and maintenance of remission in adult outpatients with moderate-severe ulcerative colitis 1. Additionally, the guidelines suggest using infliximab or vedolizumab rather than adalimumab for induction of remission in patients who are naïve to biologic agents 1. It is essential to note that the treatment approach should be individualized based on the specific type of colitis, disease severity, and patient response to therapy, as well as consideration of potential side effects and interactions, as highlighted in the guidelines 1.
From the FDA Drug Label
- 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.
The best treatment option for a patient with colitis, including severe diarrhea, is Infliximab (IV), which is indicated for reducing signs and symptoms, inducing and maintaining clinical remission, and mucosal healing in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy 2. The recommended dose 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 benefits of Infliximab (IV) include:
- Reducing signs and symptoms of colitis
- Inducing and maintaining clinical remission
- Mucosal healing
- Eliminating corticosteroid use
- Important considerations:
- Patients should have an inadequate response to conventional therapy
- Close monitoring and regular follow-up visits with a physician are required 2
From the Research
Treatment Options for Colitis
The treatment options for colitis, including severe diarrhea, depend on the severity of the disease and the patient's response to initial therapy.
- For patients with mild-to-moderate ulcerative colitis, mesalamine is considered a first-line therapy to induce and maintain clinical remission 3, 4.
- Mesalamine with Multi-Matrix System (MMX) technology is an oral, once-daily tablet formulation of mesalamine that has been shown to be effective in inducing and maintaining clinical remission in patients with active mild-to-moderate UC 3, 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.
- In cases of severe colitis, surgical intervention may be indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease 6.
- The use of corticosteroids with or without mesalamine has been studied, and while there was no significant difference in response rates between the two groups, there was a trend towards a reduced need for biologics in the mesalamine group 7.
Management of Severe Diarrhea
Severe diarrhea is a common symptom of colitis, and its management is crucial to prevent dehydration and electrolyte imbalances.
- The treatment of severe diarrhea in colitis patients typically involves the use of anti-diarrheal medications, fluid replacement, and electrolyte supplementation.
- In cases of fulminant colitis, prompt recognition and treatment are crucial to prevent serious complications, including death 6.
- The use of MMX mesalamine has been shown to be effective in reducing the frequency of diarrhea in patients with ulcerative colitis, and its once-daily dosing may improve patient adherence to therapy 3, 5.