Ulcerative colitis (UC) is a chronic condition with no known cure. However, medications, such as anti-inflammatories and immunosuppressants, can help people achieve and maintain remission or live with minimal or no symptoms.
This information comes from the Crohn’s and Colitis Foundation.
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UC is one form of inflammatory bowel disease (IBD), alongside Crohn’s disease. Gastroenterologists can prescribe various medications and treatments according to a person’s disease activity and the severity of their condition.
This article reviews the different medications for treating UC. It also describes the five main types of approved drugs for the condition, how they work, and their different uses and precautions.
These drugs are available in prescription and over-the-counter (OTC) formulations.
Aminosalicylates are a type of anti-inflammatory medication. They decrease pathways in the body that create inflammation-causing substances, helping decrease inflammation in the gastrointestinal tract.
Doctors frequently prescribe the treatment class known as 5-aminosalicylic acid (5-ASA) for mild to moderate IBD. They may administer these as a suppository or recommend that people take them orally.
Examples of aminosalicylates include:
Medical professionals prescribe this medication to maintain the remission period between acute episodes of UC.
Manufacturers sell this drug under the brand name Azulfidine. The Food and Drug Administration (FDA)
There are some important considerations a person should be aware of before taking this medication. These include:
- possible side effects such as nausea and heartburn
- a lower sperm count in males
- their unsuitability for people allergic to sulfa drugs
- reduced folic acid levels
Additionally, people who wish to become pregnant should discuss taking folate supplements with their care providers.
Doctors administer this drug in an oral capsule or as a suppository or enema.
This drug has
Doctors use this medication to help maintain remission and those who have an intolerance to sulfasalazine.
This drug’s brand name is Dipentum.
Medical professionals will not prescribe this drug if a person is allergic to medications containing salicylates, such as aspirin or mesalamine.
Doctors use this medication to treat mild to moderate active signs of UC in people older than 5 years.
Manufacturers sell this medication under the name Colazal.
Medical professionals will avoid prescribing balsalazide if a person is allergic to medications containing salicylates.
Experts recommend doctors use this medication with caution in people with a history of kidney disease.
Side effects of 5-ASA drugs
Most people can take these drugs without the risk of serious adverse effects.
Other potential side effects of the above drugs include:
A person should discuss the possible benefits and precautions of each drug with a doctor before starting a course of treatment.
Examples of these medications include:
However, people should use them with caution, as there is a potential risk of them causing flares.
Contrary to this belief, a
Additionally, a research paper stated that a low dose of aspirin to help prevent coronary artery disease (CAD) and stroke does not seem to cause flares in people with IBD. Therefore, these individuals may still be able to take low dose aspirin to help prevent CAD.
Corticosteroids are a well-established treatment for IBD and provide short-term relief of symptoms. Doctors prescribe these drugs to ease inflammation in the colon or flare-ups of UC.
However, 20–30% of people with acute symptoms of IBD will not respond to corticosteroids.
Doctors commonly prescribe the following corticosteroids for IBD:
- Prednisone: Doctors administer this as an oral tablet.
- Budesonide: People take this orally, and unlike prednisone, this drug clears the liver more quickly, reducing the risk of side effects.
- Hydrocortisone: When doctors administer these through a suppository, it reduces inflammation of the:
- sigmoid colon
- Hydrocortisone acetate: People take this by applying a rectal foam that helps deliver medication to the colon and rectum.
- Methylprednisolone: Doctors deliver this medication through an enema, which takes it higher in the colon, reducing inflammation and lowering the risk of side effects.
Side effects of corticosteroids
However, people should not use corticosteroids over the long term because they can cause the following side effects:
- greater susceptibility to infection
- weakened bones, or osteoporosis
- high blood pressure
- high blood sugar
- mood swings
- growth of facial hair
- growth issues in children
- weight gain
- developing a round or moon-shaped face
Corticosteroids can also cause short-term side effects, including:
- upset stomach
- sleeping issues
- behavioral changes
A person should consult a doctor to determine their dosage of corticosteroids to avoid and prevent possible side effects.
Doctors refer to these drugs as immunosuppressants or immunomodulators. They target IBD inflammation by managing the body’s immune system response.
Medical professionals generally prescribe them:
- when aminosalicylates and corticosteroids have not worked
- to reduce the use of corticosteroids
- to help someone stay in remission longer
It can take up to 3 months to see results from immunomodulators.
The following are common immunomodulators:
- methotrexate: oral or injectable
- cyclosporine: oral or IV injection
- azathioprine: off-label oral drug
- 6-mercaptopurine: oral drug
- tacrolimus: off-label oral and IV options
Multiple kinds of medications are available in each category:
- Anti-tumor necrosis factor agents: This type of biologic blocks a protein that causes inflammation and promotes intestinal healing. Doctors typically administer them by IV on a maintenance schedule of
every 8 weeksafter an initial dose of three. Examples include:
- Integrin receptor antagonists: This biologic
preventsinflammation by keeping the cells that cause it from getting into tissues. Doctors primarily use it in people who have not responded well to other treatments. Examples include Tysabri (natalizumab) and Entyvio (vedolizumab).
- Interleukin-12 and -23 antagonist: This type of biologic targets specific proteins that are key factors in inflammation. An example includes Stelara (ustekinumab).
Side effects of biologics
Potential side effects from biologics include:
- a higher risk of infection because of how biologics affect the immune system
- pain or itching at the injection site
- allergic reactions
- a potential for a higher risk of lymphoma
- a potential for liver problems
- skin problems
- joint pain
People can consult a doctor to discuss possible side effects and risks of these medications before starting treatment.
Experts have recently developed a new treatment for UC using JAK inhibitors.
This therapy involves small molecule compounds that break down in the gastrointestinal tract.
Once the body breaks them down, the bloodstream absorbs the molecules through the intestines and targets the immune system to reduce the response that triggers UC.
Additionally, JAK inhibitors can help treat:
There are several different types of this therapy, including:
Xeljanz (tofacitinib), an oral medication similar to Zeposia, is a small molecule drug that works by blocking enzymes that play a role in inflammation.
Zeposia is a brand name for ozanimod. Doctors prescribe this drug to help people with moderate to severe UC who have not responded well to other treatments.
In clinical studies from 2022, people were generally able to take Zeposia with limited side effects. Data showed taking ozanimod significantly improved rates of clinical remission. Additionally, early studies showed that even with long-term use, ozanimod did not seem to produce many side effects.
However, more research needs to determine its effectiveness across further trials and larger samples.
Side effects of molecular therapy
Other potential side effects include:
- upper respiratory tract infections
- blood clots
- high cholesterol
- reactivated infections, such as hepatitis B and C
Doctors will monitor cholesterol levels and screen for reactivated infections. People can discuss other possible adverse effects with a healthcare professional to determine the benefits and risk factors.
Doctors cannot cure UC, but treatment can help a person achieve remission and prevent flares of symptoms.
Many medications can treat UC, such as anti-inflammatories, immunosuppressants, biologics, and molecular therapy.
However, they all have limitations as they can cause side effects, which may make them unsuitable for long-term use. People with UC can work with their gastroenterologist to find the most suitable treatment.