Recent advances and emerging therapies in the non-surgical management of ulcerative colitis

Abstract

The so-called “biologicals” (monoclonal antibodies to various inflammatory targets like tumor necrosis factor or integrins) have revolutionized the treatment of inflammatory bowel diseases. In ulcerative colitis, they have an established role in inducing remission in steroid-refractory disease and, thereafter, maintaining remission with or without azathioprine. Nevertheless, their limitations are also obvious: lack of primary response or loss of response during maintenance as well as various, in part severe, side effects. The latter are less frequent in anti-integrin treatment, but efficacy, especially during induction, is delayed. New antibodies as well as small molecules have also demonstrated clinical efficacy and are soon to be licensed for ulcerative colitis. None of these novel drugs seems to be much more effective overall than the competition, but they provide new options in otherwise refractory patients. This increasing complexity requires new algorithms, but it is still premature to outline each drug’s role in future treatment paradigms.

Living with Ulcerative Colitis Study (LUCY) in England: a retrospective study evaluating healthcare resource utilisation and direct healthcare costs of postoperative care in ulcerative colitis

“…European guidelines recommend sustained steroid-free remission as the treatment goal. [7][8][9] Despite these options, some patients with UC require a colectomy. 10 The highest colectomy rates are seen during the first few years after diagnosis.…”

Efficacy and safety evaluation of acupoint embedding for patients with ulcerative colitis

“…Ulcerative colitis (UC) which characterize by recurring inflammation of the bowel not only brings financial strain, but also affects patients quality of life (QoL). [ 1 , 5 , 24 ] The theory of acupoints embedding is from Chinese medicine, which can balance the bodys yin and yang by continuously stimulating acupuncture points. It is getting more and more attention as a form of therapy.…”

“…[ 1 , 2 ] UC occurs on the surface of the intestinal mucosa, starting the rectum and then spreading to the entire colon. [ 3 , 4 ] In recent years, it is becoming a global disease, publications showed that UC is not only occurring in Western countries, [ 5 – 7 ] but is also increasing in developing regions such as Asia and Africa, 1 study showed that there was a six-fold increase of incidence from 1986–1988 to 2004–2006 in Hong Kong. [ 8 ] About the pathogenesis of UC, there is still no specific clinical conclusion, but most people think it is related to environment, genetics and immune.…”

Immunological mechanisms underpinning faecal microbiota transplantation for the treatment of inflammatory bowel disease

“…Drugs blocking pleiotropic proinflammatory pathways, such as steroids, immunomodulatory drugs, anti‐TNF agents, the Th1/Th17 axis via IL‐12/23 blockage and leucocyte trafficking via anti‐integrins and signalling molecules, are the mainstay of medical management of IBD . These agents are fairly effective, with steroid‐free clinical remission rates ranging from 57% for combination therapy with infliximab (anti‐TNF) and azathioprine (thiopurine) to 18% for tofactinib [targets Janus kinase/signal transducers and activators of transcription (JAK/STAT) signalling pathway] . With increasing evidence of a dysregulated intestinal microbiome being a probable immunological trigger for inflammation in IBD, exploring therapeutic manipulation of the gut microbiome is an attractive strategy to identify new treatment options, and help understand the underlying cause of IBD.…”