6 Treatment Options for Ulcerative Colitis

Finding the Right Treatment for Ulcerative Colitis

Treatment for ulcerative colitis (UC) aims to reduce symptoms, induce and maintain remission and improve quality of life. From medications like Entyvio (a biological therapy) to lifestyle modifications, there are several options available to manage UC effectively.

1. Biologic Therapies

Biologics are advanced therapies that target specific proteins involved in inflammation, offering a more targeted approach than other medications. They are generally used for moderate to severe UC that hasn’t responded to traditional treatments.

• Entyvio (Vedolizumab): Entyvio is an integrin receptor antagonist specifically designed for UC and Crohn’s disease. It works by preventing certain immune cells from entering the gut lining, which reduces inflammation. Patients receive Entyvio through intravenous infusion, usually starting with a few doses close together, then less frequently as part of maintenance.
• Infliximab (Remicade), Adalimumab (Humira) and Golimumab (Simponi): These are TNF-alpha inhibitors, which work by blocking the TNF protein that causes inflammation. Like Entyvio, they are often administered by infusion or injection and are suitable for people with moderate to severe UC.

Biologics can be highly effective, but they may also come with risks, such as an increased susceptibility to infections. Patients on biologics need regular health monitoring.

2. Aminosalicylates (5-ASAs)

Aminosalicylates are often used as the first line of treatment for mild to moderate UC. These medications work by reducing inflammation in the colon and are effective in both inducing and maintaining remission. The most common 5-ASA drugs include:

• Mesalamine (Asacol, Lialda, Apriso): An anti-inflammatory drug targeting the colon lining, typically administered orally or rectally.
• Sulfasalazine: An older but effective 5-ASA drug that also provides mild immune suppression.

Side effects of 5-ASAs can include headaches, nausea, and fatigue, though they are generally well-tolerated by many people.

3. Corticosteroids

For moderate to severe UC flare-ups, corticosteroids may be prescribed. These drugs work quickly to reduce inflammation and immune system activity, which helps manage acute symptoms. However, because of their potential for significant side effects—including weight gain, mood swings, and increased infection risk—they are not recommended for long-term use. Common corticosteroids for UC include:

• Prednisone: Often taken as a short-term course to quickly reduce inflammation.
• Budesonide (Entocort, Uceris): A localized corticosteroid that targets inflammation in the colon and minimizes systemic exposure.

While corticosteroids can help during active flare-ups, doctors typically transition patients to other maintenance medications as soon as possible.

4. Immunomodulators

Immunomodulators help suppress the immune response that drives UC inflammation and are often used for patients who do not respond well to 5-ASAs or corticosteroids. These drugs are typically slower to act, taking weeks or months to show their full effect. Common immunomodulators include:

• Azathioprine (Imuran) and Mercaptopurine (Purinethol): These medications work to decrease immune activity in the colon, helping to maintain remission.
• Methotrexate: Used occasionally for UC but more commonly prescribed for other forms of IBD.

While effective, immunomodulators require regular monitoring due to potential side effects, including liver toxicity and lowered blood cell counts.

5. Janus Kinase (JAK) Inhibitors

JAK inhibitors are a newer class of medication for UC that works by interfering with specific pathways involved in inflammation. Unlike biologics, which are administered by injection or infusion, JAK inhibitors are taken orally.

• Tofacitinib (Xeljanz): This is the most commonly prescribed JAK inhibitor for UC. It is typically prescribed when other treatments have not provided sufficient relief. Side effects can include an increased risk of infections, so regular monitoring is important.

6. Lifestyle and Diet Modifications

While medications play a central role in UC treatment, lifestyle and dietary changes can also be beneficial. Many people find that certain foods can trigger flare-ups, so a personalized approach to diet, often guided by a dietitian, can help manage symptoms. High-fiber, greasy, and spicy foods are common irritants, and many people with UC find that small, frequent meals are gentler on the digestive system.

Incorporating stress-reducing techniques, such as yoga, meditation, and regular exercise, can also improve overall well-being and symptom management.

When to Talk to Your Doctor

It’s essential to work closely with a healthcare provider to develop an individualized treatment plan for UC. You should talk to your doctor if:

• You experience worsening symptoms or more frequent flare-ups.
• Current treatments are no longer effective or have intolerable side effects.
• You have questions about trying a new treatment, like Entyvio, or switching from one medication to another.
• You notice any unusual symptoms, such as fevers, unexplained weight loss, or changes in your bowel habits, which may signal complications.

Staying informed about your options and maintaining open communication with your healthcare provider can help you manage UC more effectively, promoting a higher quality of life and more consistent remission.