Medical approaches and future options in chronic active ulcerative colitis.
BACKGROUND
Immunosuppressive therapy employing purine analogues is the therapeutic mainstay in patients with chronic active ulcerative colitis. However, despite therapeutic optimization according to thiopurine-methyltransferase activity or red blood cell 6-thioguanine levels, a substantial proportion of patients does not tolerate azathioprine or 6-mercaptopurine or relapses during this treatment. In the latter multiple therapeutic regimens comprising 6-thioguanine, cyclosporin or tacrolimus, methotrexate, cyclophosphamide, infliximab, interferons, heparin, leukocyte apheresis, and various other regimens might be considered aiming at long-term remission. Many of these treatment forms have only been evaluated in small mostly uncontrolled trials.


OBJECTIVE
In this review existing treatment modalities and future options for patients with chronic active ulcerative colitis will be discussed focusing on immunomodulating approaches.
Siveke
J T
JT
II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Folwaczny
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C
D000287:Administration, Topical; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000628:therapy*; D016207:Cytokines / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016023:Integrins / Q000037:antagonists & inhibitors; D007937:Leukapheresis; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000636:Aminosalicylic Acids; D016207:Cytokines; D005343:Fibrinolytic Agents; D007166:Immunosuppressive Agents; D016023:Integrins; D014409:Tumor Necrosis Factor-alpha; C071777:integrin alpha4beta7; D006493:Heparin