Update on the Management of Ulcerative Colitis

  • Frank Hoentjen
  • Atsushi Sakuraba
  • Stephen Hanauer
Article

Abstract

The treatment options for inflammatory bowel disease have expanded with the introduction of biological therapies. Recently published controlled clinical trials were searched and those that impact the clinical management of ulcerative colitis (UC) are discussed in this review. In the management of mild to moderate UC, mesalamine still remains the first choice of drug. The newly developed once daily formulations have shown equal efficacy to divided doses and possibly portend better compliance owing to a simplified regimen. In outpatients with moderate to severe UC, recent data indicate that infliximab induced and maintained remission leads to decreased colectomy rates and fewer hospitalizations. An alternative anti-tumor necrosis factor (TNF) agent, adalimumab, was also recently shown to be effective for induction of remission in moderate to severe UC. The use of immunosuppressives, such as azathioprine and mercaptopurine, is associated with decreased colectomy rates and thioguanine was shown to be effective in maintaining clinical remission in those who are intolerant to azathioprine/mercaptopurine. In hospitalized patients with steroid resistant severe UC, infliximab and tacrolimus may be alternatives to cyclosporine in those who are otherwise candidates for colectomy. Adequate long-term maintenance therapy with immunosuppressives or anti-TNF therapy is required after rescue therapy for a sustained benefit. Future research is needed to position the available anti-TNF agents and combined immunosuppressive therapy in the treatment of UC to achieve and maintain steroid free remission.

Keywords

Ulcerative colitis Anti-tumor necrosis factor Azathioprine Colectomy Cyclosporine Mercaptopurine Mesalamine Thioguanine Thiopurines Tacrolimus 

Notes

Disclosure

Stephen B. Hanauer is a board member of the American College of Gastroenterology and has worked as a consultant for Abbott Labs, Centocor, Ferring, Meda, Salix, Shire, and Warner-Chilcott; Frank Hoentjen and Atsushi Sakuraba reported no potential conflicts of interest relevant to this article.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Frank Hoentjen
    • 1
    • 2
  • Atsushi Sakuraba
    • 1
  • Stephen Hanauer
    • 1
  1. 1.Section of Gastroenterology, Hepatology and Nutrition, Department of MedicineThe University of ChicagoChicagoUSA
  2. 2.Department of GastroenterologyFree University Medical CenterAmsterdamThe Netherlands

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