title: Maintenance therapy options for ulcerative colitis.
abstract: BACKGROUND
  Medical therapy is the cornerstone of the management of ulcerative colitis (UC) and the goal of the treatment is the induction and maintenance of remission.
  
  
  METHODS
  Mesalamine is the first line treatment in patients with mild to moderate UC. Despite having different formulations available, clinically significant differences in pharmacokinetics and exposure to these drugs have not been observed. Evidence supporting the efficacy of azathioprine and mercaptopurine for maintaining remission is UC patients come from both observational cohorts and clinical trials. The main limitation of the treatment with thiopurines is the onset of adverse events that occur in over one-third of patients. Infliximab, adalimumab and golimumab are anti-TNF drugs, which are generally used for more severe or refractory cases. Finally, vedolizumab, a drug directed against the integrins α4β7 has been shown to be effective for the induction and maintenance of remission in moderate-to-severe UC patients.
  
  
  CONCLUSIONS
  Several new drugs have enriched the therapeutic armamentarium of UC. Whether the administration of biologics earlier on in the course of the disease would have an impact on the natural history of the disease, avoiding the need for colectomy, remains unknown.
authors.affiliation: a Gastroenterology Unit , Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Madrid , Spain.
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.affiliation: a Gastroenterology Unit , Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Madrid , Spain.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D001688:Biological Products; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Ulcerative colitis; adalimumab; azathioprine; biosimilar; golimumab and vedolizumab; infliximab; mercaptopurine; mesalamine