Emerging oral drug options for ulcerative colitis

ABSTRACT

Introduction

Despite the availability of a variety of therapeutic compounds and improved management strategies, one-third of UC patients with moderate-to-severe disease do not benefit from the existing treatments or experience drug-related side effects. This has boosted intensive research focusing on the development of new drugs for UC therapy. This article aims to summarize the available evidence on oral drugs, which are now being explored in clinical trials or are ready to enter the clinics.

Areas covered

From May 15 to June 11, we searched on PubMed using the keywords ‘oral drugs ulcerative colitis,’ ‘ulcerative colitis clinical trials,’ ‘UC phase 2 and 3 trials’ excluding case reports, case series, phase 1 and 4 studies, and studies about approved therapies.

Expert opinion

The findings discussed in this article suggest that the future treatment of UC patients will be probably characterized by the possibility of using various small-molecule drugs. All these new compounds, even those belonging to the same class, differ in terms of efficacy and safety. Identification of predictors of response could help optimize the efficacy and safety of these treatments, thus improving resource allocation through a pretreatment stratification of patients.

KEYWORDS:

• IBD
• gut inflammation
• cytokines
• integrins
• Jak inhibitors

Article highlights

• More than one third of patients with moderate-to-severe ulcerative colitis (UC) does not respond to current biologics or small molecules.

• Accumulating evidence suggests that JAK and S1PR molecules are therapeutic targets in UC.

• The efficacy and safety profile of several JAK and S1PR blockers have been recently tested in phase II and III trials in UC with promising results.

• Regulation of microRNA expression is a novel way to modulate the mucosal inflammation in UC.

Declaration of interest

G Monteleone served as a consultant for First Wave BioPharma, as a speaker for Takeda, AbbVie, Galapagos and Pfizer, and filed a patent related to the treatment of inflammatory bowel diseases with Smad7 antisense oligonucleotides. I Marafini served as a speaker for Janssen and Galapagos. 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.