Current and emerging maintenance therapies for ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic idiopathic intestinal disease that requires life-long maintenance therapy to maintain clinical remission. This article reviews the current literature on maintenance treatments in UC. It examines the natural history of the condition and the proposed benefits of treatment. These include improving quality of life parameters, decreasing corticosteroid intake, the prevention of relapse, the prevention of colorectal cancer and the avoidance of colectomy. The immunosuppressive era appears to be reducing the need for elective colectomy in UC. The article explores the classes of drug currently used for maintenance of UC, reviews the literature around adherence issues, and summarizes emerging agents in this space.

Keywords::

• 5-ASA
• adalimumab
• golimumab
• infliximab
• maintenance
• remission
• thiopurines
• ulcerative colitis

Financial & competing interests disclosure

A O’Connor has received a traveling fellowship from MSD Human Health. AC Moss has received research grants from Pfizer, Salix, Shire & Aptalis. The author has been a consultant for Jannsen and UCB. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The benefits of maintenance therapy in ulcerative colitis (UC) include improving quality-of-life parameters, decreasing corticosteroid intake, the prevention of relapse, the prevention of colorectal cancer and the avoidance of colectomy.

• A universally used definition of disease remission in UC is currently lacking and would be a major benefit.

• 5-aminosalicylic acid medications, thiopurines and anti-TNF antibodies are all efficacious in preventing relapse in patients with UC in clinical remission. The choice of agent in practice is influenced by disease severity, prior therapeutic failures and safety considerations.

• Adherence to maintenance treatment is critical to reducing patients’ risk of relapse or future complications.

• Maintenance agents that induce histological remission appear to provide protection against an individual’s risk of colon cancer.