title: Medical Therapy of Active Ulcerative Colitis.
abstract: BACKGROUND
  Medical therapy of mild and moderate ulcerative colitis (UC) of any extent is evidence-based and standardized by national and international guidelines. However, patients with steroid-refractory UC still represent a challenge.
  
  
  METHODS
  A literature search using PubMed (search terms: ulcerative colitis, therapy, new, 1-2008-2015) resulted in 821 publications. For the current article, 88 citations were extracted including 36 randomized controlled studies, 18 reviews, and 8 meta-analyses.
  
  
  RESULTS
  In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. In patients with chronic disease activity, treatment with anti-TNF antibodies has a higher level of evidence than azathioprine therapy and should therefore be preferred. However, there is a subgroup of UC patients who may achieve prolonged steroid-free remission on azathioprine monotherapy. The importance of vedolizumab, a newly registered inhibiting antibody against integrin, has not yet been fully clarified since direct comparison studies are lacking, in particular in relation to anti-TNF antibodies.
  
  
  CONCLUSIONS
  There is a great need for additional innovative therapies, especially in cases of primary non-response or secondary loss of response to anti-TNF antibodies. New small molecules (Janus kinase inhibitors) are promising with an acceptable safety profile and efficacy in UC. Further, strategies that target the intestinal microbiome are currently considered for patients with active or relapsing UC, and may in the future open up new therapeutic options.
authors.affiliation: Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bürger
authors.affiliation: Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Group Practice for Digestive and Metabolic Diseases, Leipzig, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Teich
authors.affiliation: Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
keywords: Anti-TNF; Fecal microbiota transfer; Innovations; Medical therapy; Ulcerative colitis; Vedolizumab