Emerging Treatment Options in Mild to Moderate Ulcerative Colitis.
Ulcerative colitis (UC) is a chronic inflammatory condition associated with rectal bleeding and urgency, tenesmus, and diarrhea. Several medical therapies can be used in the treatment of UC. Aminosalicylates are widely used based on their efficacy in the induction and maintenance of remission. Although corticosteroids are effective in patients with more severe disease, systemic use is associated with significant safety concerns. The newer corticosteroid budesonide has lower systemic bioavailability and, consequently, a more favorable safety profile. A budesonide extended-release formulation allows once-daily dosing and delivers the agent locally throughout the colon. Biologic agents used for the treatment of moderate to severe UC include the tumor necrosis factor inhibitors infliximab, adalimumab, and golimumab, and the integrin inhibitor vedolizumab. Rectally administered therapy can also be useful in the treatment of UC. In October 2014, the US Food and Drug Administration approved a budesonide foam formulation for inducing remission in patients with active mild to moderate distal UC extending up to 40 cm from the anal verge. Budesonide foam rapidly distributes to the sigmoid colon and the rectum and avoids some of the drawbacks of suppositories and enemas.
Professor of Medicine Director, Center for Inflammatory Bowel Disease University of Pennsylvania Health System Hospital of the University of Pennsylvania Philadelphia, Pennsylvania.
Gary R
GR
Lichtenstein
Professor of Medicine Feinberg School of Medicine Medical Director, Digestive Health Center Northwestern Medicine Chicago, Illinois.
Stephen B
SB
Hanauer
Professor of Medicine and Adjunct Professor of Surgery Chief, Division of Gastroenterology Director, UCSD IBD Center University of California San Diego University of California San Diego Health System La Jolla, California.
William J
WJ
Sandborn