Contemporary Management of Ulcerative Colitis
- 670 Downloads
Purpose of Review
We discuss the newest evidence-based data on management of ulcerative colitis (UC). We emphasize risk-stratification, optimizing medical therapies, and surgical outcomes of UC.
Recent medical advances include introduction of novel agents for UC. Vedolizumab, an anti-adhesion molecule, has demonstrated efficacy in moderate to severe UC. Tofacitinib, a small molecule, has also demonstrated efficacy. Data on optimization of infliximab show the superiority of combination therapy with azathioprine over monotherapy with infliximab or azathioprine alone. Data on anti-tumor necrosis factor-alpha (anti-TNF) therapeutic drug monitoring also hold promise, as do preliminary data on the dose escalation of infliximab in severe hospitalized UC. Surgical outcome data are reassuring, with new fertility data showing the effectiveness of in vitro fertilization.
UC management is multi-disciplinary and changing. While novel therapies hold promise, better optimization of our current arsenal will also improve outcomes.
KeywordsUlcerative colitis Management Review Therapeutic drug monitoring
Compliance with Ethical Standards
Conflict of Interest
Rohini Vanga declares no conflict of interest.
Millie Long reports grants and personal fees from Takeda and personal fees from Pfizer, AbbVie, UCB, Target, and Pharmasolutions, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 16.Wang Y, Parker CE, Feagan BG, MacDonald JK. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2016;9(5):CD000544.Google Scholar
- 20.Sherlock ME, MacDonald JK, Griffiths AM, Steinhart AH, Seow CH. Oral budesonide for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2015;26(10):CD007698.Google Scholar
- 22.Carbonnel F, Colombel JF, Filippi J, Katsanos KH, Peyrin-Biroulet L, Allez M, et al. Methotrexate is not superior to placebo for inducing steroid-free remission, but induces steroid-free clinical remission in a larger proportion of patients with ulcerative colitis. Gastroenterology. 2016;150(2):380–8.e4.CrossRefPubMedGoogle Scholar
- 24.• Panaccione R, Ghosh S, Middleton S, Márquez JR, Scott BB, Flint L, et al. Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology. 2014;146(2):392–400.e3. Demonstrates the importance of combination therapy with infliximab and azathioprine over either agent along in UC; ultimately changing treatment paradigms. CrossRefPubMedGoogle Scholar
- 32.•• Vande Casteele N, Ferrante M, van Assche G, Ballet V, Compernolle G, van Steen K, et al. Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease. Gastroenterology. 2015;148(7):1320–9.e3. A randomized controlled trial of prospective therapeutic drug monitoring of infliximab showed no benefit at 1 year of concentration-based dosing as compared to clinically based dosing CrossRefPubMedGoogle Scholar
- 33.Papamichael K, Chachu KA, Vajravelu RK, Vaughn BP, Ni J, Osterman MT, et al. Improved long-term outcomes of patients with inflammatory bowel disease receiving proactive compared with reactive monitoring of serum concentrations of infliximab. Clin Gastroenterol Hepatol. 2017;15(10):1580–1588.e3.CrossRefPubMedGoogle Scholar
- 34.Vaughn BP, Martinez-Vazquez M, Patwardhan VR, Moss AC, Sandborn WJ, Cheifetz AS. Proactive therapeutic concentration monitoring of infliximab may improve outcomes for patients with inflammatory bowel disease: results from a pilot observational study. Inflamm Bowel Dis. 2014;20(11):1996–2003.CrossRefPubMedPubMedCentralGoogle Scholar
- 44.•• Sandborn WJ, Su C, Sands BE, D'Haens GR, Vermeire S, Schreiber S, et al. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017;376(18):1723–36. A first in class oral small molecule agent for induction and maintenance of UC will provide a needed new class of therapy once approved in 2018 CrossRefPubMedGoogle Scholar
- 45.Langhorst J, Anthonisen IB, Steder-Neukamm U, Lüdtke R, Spahn G, Michalsen A, et al. Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey. Inflamm Bowel Dis. 2005;11(3):287–95.CrossRefPubMedGoogle Scholar