Review article: evolving concepts in treatment and disease modification in ulcerative colitis

Abstract

Summary Background More than two‐thirds of ulcerative colitis patients experience at least one relapse over a period of 10 years. Treatments that reduce the likelihood of relapses also reduce the risk of long‐term complications. Aim To review three topics: the current standard of treatment for ulcerative colitis, evolving concepts in treatment, and disease modification as a treatment goal of the future. Results Currently, 5‐aminosalicylates are the standard treatment for the induction and maintenance of remission in mild‐to‐moderate ulcerative colitis patients. Evidence suggests that patients who take oral 5‐aminosalicylates regularly are nearly six times more likely to experience regression in disease severity than those who do not. Additional treatment options such as corticosteroids, immunomodulators, biological therapies and ciclosporin are available for moderate‐to‐severe ulcerative colitis patients, or those who do not respond to 5‐aminosalicylate. Surgery becomes pertinent for more than one‐third of ulcerative colitis patients during the course of their disease. With the availability of a variety of therapies, advances in surgery and improved management strategies, a better understanding of patient treatment expectations can help improve the quality of care for ulcerative colitis patients. Conclusions Disease modification is increasingly becoming a treatment goal in the management of ulcerative colitis. However, long‐term studies are needed to examine further the disease modifying role of 5‐aminosalicylates.

Azathioprine maintains long-term steroid-free remission through 3 years in patients with steroid-dependent ulcerative colitis†

“…Reducing the episodes of relapses, it is possible to reduce the risk of longterm complications and improve patient quality of life. 3 Corticosteroids remain one of the most effective therapies for inducing remission in patients with moderateto-severe UC. 4 Approximately 50%-80% of patients prescribed corticosteroids will experience a rapid relief of symptoms.…”

Unmet Medical Needs in Ulcerative Colitis: An Expert Group Consensus

“…Patients who regularly use oral aminosalicylates are 5.8 times more likely to experience disease regression than those who do not [65], and oral aminosalicylates may also protect against the proximal extension of mucosal inflammation in UC [65]. This suggests a disease-modification role for oral aminosalicylates in UC [65]. There is also evidence that thiopurines and anti-TNF treatments have the potential for disease modification in UC [63,66].…”

“…During the early stages of UC, relapses are associated with a hastening of disease progression [65]. Patients who regularly use oral aminosalicylates are 5.8 times more likely to experience disease regression than those who do not [65], and oral aminosalicylates may also protect against the proximal extension of mucosal inflammation in UC [65].…”

The Role of Biologics in Ulcerative Colitis

“…The current treatment goals for the therapy of ulcerative colitis have been, primarily, clinical goals that include: induction of clinical remission (absence of blood or rectal urgency, formed bowel movements without nocturnal symptoms and the return of rectal compliance), maintenance of steroid-free clinical remissions, and prevention of complications related to the disease (colectomy, hospitalization, disability, and unemployment) or therapy (allergies, infections, lymphoma and steroid-related side effects) [1,2] . Therapeutic options that have been demonstrated to induce remissions in mild-moderate active disease include oral and topical aminosalicylates and topical corticosteroids whereas oral corticosteroids have been demonstrated to induce clinical remissions in moderate-severe disease.…”

“…(and usually required) to maintain remissions induced by cyclosporine [1,2] . Hence, for most patients the long-term management of ulcerative colitis is sequential based on clinical evidence for induction and maintenance based upon the severity of disease at presentation and, according to the previous response for patients with relapsing disease.…”