Maintenance therapy options for ulcerative colitis

ABSTRACT

Introduction: 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.

Areas covered: 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.

Expert opinion: 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.

KEYWORDS:

• Ulcerative colitis
• mesalamine
• azathioprine
• mercaptopurine
• infliximab
• biosimilar
• adalimumab
• golimumab and vedolizumab

Article Highlights

• Combined oral and rectal salycilates are more effective than each option separately in maintaining remission in UC.

• Thiopurines are effective in maintaining remission in UC.

• Anti-TNF agents (infliximab, adalimumab and golimumab) are effective in inducing and maintaining remission in UC.

• Vedolizumab is effective in inducing and maintaining remission in UC.

This box summarizes key points contained in the article.

Declaration of interests

M Chaparro has served as a speaker, advisory member for or has received research funding from Merck Sharp & Dohme, Abbvie, Hospira, Takeda and Shire Pharmaceuticals. JP Gisbert has served as a speaker, a consultant and advisory member for or has received research funding from Merck Sharp & Dohme, Abbvie, Hospira, Kern Pharma, Takeda, Janssen, Pfizer, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical and Vifor Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.