title: Update on the management of ulcerative colitis.
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.
authors.affiliation: Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago, 5841 S. Maryland Ave. MC 4076, Chicago, IL 60637, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Hoentjen
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakuraba
authors.forename: Stephen
authors.initials: S
authors.lastname: Hanauer
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors; D016360:Clostridioides difficile; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000821:virology; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D065095:Calcineurin Inhibitors; D007155:Immunologic Factors; D007166:Immunosuppressive Agents