The safety of non-biological treatments in Ulcerative Colitis

ABSTRACT

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with a relapsing-remitting course that determines significant morbidity and can associate with local complications and/or extra-intestinal manifestations. Pharmacological therapies are often required for a lifetime with possible risks of toxicity and side effects.

Areas covered: Non-biological therapies (i.e. aminosalicylates, corticosteroids and immunosuppressive drugs) are widely used in UC patients for controlling the active phases of the disease and maintaining remission.

Expert Opinion: Aminosalycilates have a good safety profile with a low risk of idiosyncrasic reactions. In contrast, the use of corticosteroids and immunosuppressive drugs can associate with unacceptable side effects, some of which are potentially life threatening. Mechanisms underlying the development of these side effects are not fully understood and strategies aimed to prevent them have not yet been standardized. However, clinicians should monitor the patients during therapy to recognize the adverse events at an early stage of the occurrence. New drugs that selectively target molecules involved in the amplification of the ongoing mucosal inflammation are currently under investigation. Preliminary data indicate that such compounds have better overall safety and tolerability than corticosteroids and immunosuppressive drugs.

KEYWORDS:

• Inflammatory bowel disease
• Aminosalicylates
• Corticosteroids
• Thiopurines
• Immunomodulators

Article highlights

• Ulcerative colitis is a chronic disease, which typically requires long-term therapy.

• Aminosalycilates are safe, with low rates of adverse events even when administered for long periods.

• Corticosteroids have several well-known side effects and their use should be limited to the control of active phases.

• Immunosuppressants are useful steroid-sparing agents but have potential life-threaten side effects, which must be recognized and managed as soon as possible.

• Several new compounds are under investigation for the treatment of active ulcerative colitis but their safety profile remains to be ascertained.

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Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper has not been funded.