Medication to treat colitis

Contents

IBD Medications

I feel fine, so do I still need to take my medicine?

Yes! In the past, patients were treated only when they had symptoms to minimize exposure to the drugs used. However, we now appreciate that Crohn’s disease may be active even when you don’t have any symptoms at all. The goals of treatment are to make you feel better, but also to suppress silent disease activity. Suppressing disease that you can’t feel is important not only to prevent future flares, but also to prevent irreversible bowel damage.

Why not just take prednisone when I need it?

Prednisone is a steroid, similar to the steroids that our body naturally makes in response to stress or illness. Prednisone suppresses the immune system and reduces inflammation, which is why it has been used in many inflammatory conditions, including Crohn’s and ulcerative colitis. In the short term prednisone can help quickly control disease inflammation, however it has a number of undesirable and dangerous effects when used for too long. Immediate side effects include mood changes (sometimes severe), changes in appetite, insomnia, blurry vision, and acne. When used for many months prednisone also causes severe weakening of the bones (osteoporosis), diabetes, easy bleeding, swelling of the face and legs, and other hormone related side effects. Prednisone can help you feel better in the short term, however number studies have shown there is no long-term benefit to using prednisone. In addition, steroids make it very hard for wounds to heal and leave you very susceptible to infection. People that are on steroids that require surgery are 10-20 times more likely to have a severe problem after surgery due to steroid use. Because of the lack of long-term benefit and high likelihood of severe health problems with long-term use, we do not use prednisone except in special situations.

What are 5-ASAs (Asacol, Mesalamine, Lialda, Apriso, Colazol, Canasa and others)?

Aminosalicylates are a type of medicines used to treat ulcerative colitis. They are most often called 5-ASAs, which is short for 5-aminosalicylic acid. 5-ASAs work on the lining of the gut to reduce inflammation by decreasing things that cause inflammation. 5-ASAs work better for ulcerative colitis than for Crohn’s disease because ulcerative colitis affects only the lining of the intestines, whereas Crohn’s disease affects the deeper layers of the intestines.

5-ASAs are the first choice to treat mild to moderate ulcerative colitis. ASAs are very effective at reducing inflammation which decreases symptoms and prevents flares. ASAs work for about 75% of those with ulcerative colitis. When you take a 5-ASA regularly, it also helps to protect you from developing colon cancer. These medicines work only when the colon is affected by the disease.

Some of the 5-ASA medications are taken by mouth; others are given as a suppository (Canasa) or an enema (Rowasa). Very often, oral and rectal mediations are given together for improved disease control.

Are 5-ASA Medications Safe?

5-ASAs generally cause very few side effects. The most common and less serious side effects of 5-ASAs include headache, abdominal pain, belching, nausea, diarrhea, and pharyngitis (sore throat). The enema and suppository form of mesalamine cause even fewer side effects. Signs that your body is not able to tolerate these medicines include cramping, severe abdominal pain, and bloody diarrhea, and sometimes fever, headache, or rash. Call your health care team right away as you may need to stop taking the medicine. How is your doctor watching this? Shouldn’t the patient be watching and call right away. Do not be alarmed; 5-ASAs may turn your urine to a brown-yellow color.

As noted above, 5-ASAs can cause kidney problems but this is very rare. 5-ASAs may also make the varicella (chickenpox) vaccine more toxic. This is called Reye’s syndrome and occurs in children. Children should never be given aspirin and 5-ASAs while they are ill with chickenpox or have just received the chickenpox vaccine.

What are Imuran (azathioprine) and 6-Mercaptopurine (6-MP)?

Azathioprine and 6-MP are purine synthesis inhibitors, which have been used for over 30 years in Crohn’s disease and ulcerative colitis, rheumatoid arthritis, and for organ transplants. By decreasing the number of white blood cells that are made these medications reduce the activity of your immune system enough to control the inflammation, but not so much to leave you susceptible to a lot of infection. A majority of patients with IBD find this medication to be very effective.

What problems can occur when using Imuran (azathioprine) or 6-Mercaptopurine (6-MP)?

Every medication has some potential for side effects. It is possible to have side effects when on azathioprine, including headaches, nausea, rash, or fever. Imuran sometimes can work too well and reduce your white blood cell count too much. This can make you potentially more susceptible to some infections. For this reason we will perform regular blood work to help assure your safely. Rarely, pancreatitis can occur in people taking azathioprine.

Is there an increased risk of cancer when using Imuran (azathioprine) and 6-Mercaptopurine (6-MP)?

There is an increased risk of some cancers when using azathioprine, including skin cancer and lymphomas. The risk of lymphoma is increased by 2-4 times. However, because these complications are still relatively rare, in many cases the potential benefits for controlling the Crohn’s disease far outweigh these potential risks.

Why are doctors changing my dose of Imuran (azathioprine) and 6-Mercaptopurine (6-MP)?

Azathioprine dose is personalized and is determined by multiple factors including your weight, genetics, and other medications you may take. Don’t be surprised if your doctor occasionally increases or decreases the dose, this is common. Also keep in mind that it typically takes 6-12 weeks to notice the effects of azathioprine or 6-MP.

Final points when using Imuran (azathioprine) and 6-Mercaptopurine (6-MP)

  • Always have your labs done at intervals recommended by your doctor.
  • Wear sunscreen and be mindful of high sun exposure.
  • Tell your doctor if you are using gout medicines like allopurinol, as this may interfere with thiopurines.
  • Do not take herbal products, including Echinacea and Cat’s claw as they affect thiopurines

What are Remicade (infliximab), Humira (adalimumab), and Cimzia (certolizumab pegol)

There are three anti-TNF medicines used to treat Crohn’s disease and ulcerative colitis: infliximab (Remicade®), adalimumab (Humira®), and certolizumab pegol (Cimzia®). Anti-TNF-alpha medications suppress the immune system by blocking a very specific agent called tumor necrosis factor (TNF). There are many chemicals in your body that cause and regulate inflammation. TNF appears to be very important in inflammatory bowel disease. These medications are antibodies that bind to and block the activity of TNF. These medications are often used when azathioprine or methotrexate are not sufficient. In some individuals, there are factors that indicate Anti-TNF medications should be used before azathioprine or methotrexate.

How are Remicade (infliximab), Humira (adalimumab), and Cimzia (certolizumab pegol) administered?

Remicade is an IV infusion, it was the first anti-TNF medication that was effective in inflammatory bowel disease. After an induction period, it is given every 6-8 weeks. Patients come to an outpatient infusion center, get an IV line placed, and the drug is infused over 1-3 hours. Humira and Cimzia are both anti-TNF agents that you administer to yourself at home. It takes time to measure the full effect of anti-TNFs; usually 6-12 weeks. Anti-TNFs work best when used long-term. Once started, you should not stop using anti-TNFs unless stopped by your physician; missing doses or stopping these medications often leads to a loss of effectiveness.

What risks are associated with Remicade (infliximab), Humira (adalimumab), and Cimzia (certolizumab)?

Likely all immune suppressants, anti-TNFs generally increase the chance of infection and some cancers. However, the possible risks of these medications are very often far outweighed by the benefits. People may have an allergic reaction or other common side effects like headaches or rash. Always talk to your doctor if you are experiencing side effects as sometimes it is in your interest to tolerate these side effects, whereas in some situations the drug must be stopped.

What infections are associated with Remicade (infliximab), Humira (adalimumab), and Cimzia (certolizumab)?

There are a few specific infections that require attention when using anti-TNF agents. Tuberculosis (or TB) is a serious bacterial infection. Some people may have TB that is dominant but can reactivate and cause problems after starting an anti-TNF. People at risk of having dormant TB are healthcare workers, people who have been in or worked in prison, military stationed overseas, people who have lived in Central America, Mexico, or Eastern Europe. We test patients for TB prior to starting anti-TNF medications using a blood or skin test. hepatits B and C can get worse when people start anti-TNF medications. Fungal infections like histoplasmosis also occur more frequently for people on immunosuppressants, especially anti-TNF agents. If you develop shortness of breath, sustained fever of over 101.0 degrees, or a chronic cough, let your doctor’s office know right away. These medications increase your risk for other infections, if you develop an infection contact your doctor for instruction on what to do with your anti-TNF medication.

Is there a risk of cancer from Remicade (infliximab), Humira (adalimumab), and Cimzia (certolizumab)?

There is an increased risk of lymphoma when using anti-TNF agents. Your doctors are aware of these considerations and carefully use anti-TNFs and all immunosupressants when we believe you have a lot to gain from the medications.

What do I need to know about Methotrexate?

Methotrexate reduces the activity of your immune system in a different way than azathioprine or 6-mercaptopurine. Methotrexate has been used for over 40 years so we know a lot about how to use it and know that it is safe to use this medicine for a longtime. Methotrexate has been shown to significantly improve symptoms and prevent future symptoms. It is available as a pill or injection; however, the injection has been shown to be better in inflammatory bowel disease. Like with azathioprine and 6-MP, you need have regular blood work performed for your safety. As with all medications there are some risks. Methotrexate can suppress your bone marrow (lower your blood counts), it can cause liver and lung problems very rarely. Some people will experience nausea and fatigue after taking methotrexate. All immunosupressants to increase your general risk of infection; however, this is not often a problem when using methotrexate at low doses. Patients often notice an improvement in symptoms 4-8 weeks after starting methotrexate.

  • Everyone on methotrexate must have regular lab work performed for your safety.
  • Methotrexate is taken ONCE A WEEK, not daily.
  • When taking methotrexate you should also take folic acid 1mg every day.
  • If you are considering becoming pregnant you SHOULD NOT use methotrexate. If you are a woman of childbearing age you need to avoid becoming pregnant.

Medication Options for Ulcerative Colitis

Medication is the first line of treatment for ulcerative colitis. Your doctor’s recommendation for which medication will work best for you is based on the severity of your disease, your overall health, and other individual factors.

There are six major classes of medication used to treat ulcerative colitis.

Aminosalicylates (5-ASA)

Aminosalicylates are medications that contain 5-aminosalicylic acid (5-ASA) and work in the lining of the gastrointestinal tract to decrease inflammation. Aminosalicylates work best in the colon and are often given orally in the form of delayed release tablets, or rectally as enemas or suppositories.

Aminosalicylates are thought to be effective in treating mild-to-moderate ulcerative colitis flares and can be useful as a maintenance treatment in preventing relapses of the disease.

Examples

  • Sulfasalazine

  • Mesalamine

  • Olsalazine

  • Balsalazide

Aminosalicylates

Video Length 00:01:04

Aminosalicylates Aminosalicylates are compounds that contain 5-aminosalicylic acid (5-ASA) and reduce inflammation in the lining of the intestine. Watch this video to learn more.

Corticosteroids

Corticosteroids suppress the immune system and are used to treat moderate to severely active ulcerative colitis. These drugs work non-specifically, meaning that they suppress the entire immune response, rather than targeting specific parts of the immune system that cause inflammation. These medications are available orally and rectally.

Corticosteroids have significant short and long-term side effects and should not be used as a maintenance medication. Because they cause the adrenal glands to slow or even stop producing the body’s natural cortisol, these medications cannot be stopped abruptly.

If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to prescribe other medications to help manage your disease.

Examples

  • Prednisone

  • Prednisolone

  • Methylprednisolone

  • Budesonide

Corticosteroids for IBD

Video Length 00:01:13

Corticosteroids for IBD Corticosteroids are powerful and fast-acting anti-inflammatory drugs that have been frequently used in the treatment of acute flare-ups of IBD. Watch this video to learn more.

Immunomodulators

This class of medication controls or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators, which may take several months to begin working, are generally are used when aminosalicylates and corticosteroids haven’t been effective, or have been only partially effective.

These medications may be useful in reducing or eliminating the need for corticosteroids, and in maintaining remission in people who haven’t responded to other medications given for this purpose. Some immunomodulators are used to make other medications, such as biologics, work better.

Examples

  • Azathioprine

  • 6-mercaptopurine

  • Cyclosporine

  • Tacrolimus

Immunomodulators for IBD

Video Length 00:01:10

Immunomodulators for IBD Immunomodulators weaken or modulate the activity of the immune system. And are medications often used to treat people with IBD. Watch this video to learn more.

Janus Kinase (JAK) Inhibitors

Janus kinase (JAK) inhibitors suppress your immune system by blocking the JAK enzyme and preventing it from activating the specific immune system cells that cause inflammation. These medications, taken orally, are FDA approved to treat moderate-to-severe ulcerative colitis.

Example

Tofacitinib

IBD Medications: JAK Inhibitors

Video Length 00:01:24

IBD Medications: JAK Inhibitors JAK inhibitors are proteins that suppress your immune system and work quickly to induce and maintain remission.

Biologic/Biosimilar Therapies

Biologics are used to treat people with moderate-to-severe ulcerative colitis. Unlike other medications, biologics are protein-based therapies that are created out of material naturally found in life. These medications are antibodies that stop certain proteins in the body from causing inflammation.

Examples

  • Adalimumab

  • Golimumab

  • Infliximab

  • Ustekinumab

  • Vedolizumab

Biologics for IBD

Video Length 00:01:21

Biologics for IBD Biologics are antibodies grown in the laboratory that stop specific proteins in the body from causing inflammation. Their mechanisms of action are more precisely targeted to the factors responsible for IBD.

Biosimilars are nearly identical copies of other already approved biologic therapies. They have the same effectiveness and safety as the originally approved biological therapy, which is called the originator drug or reference product. Learn about recently approved biosimilars and other medications.

Examples

  • Infliximab-abda

  • Infliximab-dyyb

  • Infliximab-qbtx

Ulcerative colitis medications and other options

There is no cure for UC, but there are several medications that may relieve the symptoms. The type of medicine a doctor prescribes will depend on how severe the disease is.

Medications may include:

Share on PinterestA doctor may prescribe medication to treat the symptoms of ulcerative colitis.

Aminosalicylates are a group of drugs. Doctors also call them 5-ASAs because they contain the anti-inflammatory 5-aminosalicyclic acid.

Doctors usually prescribe them to people who have mild or moderate symptoms and may include:

  • balsalazide
  • mesalamine
  • olsalazine
  • sulfasalazine

Possible side effects include:

  • abdominal pain
  • headache
  • nausea

People commonly refer to these medicines as steroids. They work by decreasing the activity of the immune system, which is the cause of the inflammation.

Doctors usually prescribe steroids for people who experience more severe symptoms. However, they may be a potential option if 5-ASAs are not effective.

Steroids that may treat UC include:

  • budesonide
  • hydrocortisone
  • methylprednisone
  • prednisone

Possible side effects include:

  • acne
  • susceptibility to infection
  • loss of bone mass
  • high blood glucose
  • high blood pressure
  • mood swings
  • weight gain

These are a group of medicines that reduce the activity of the immune system. Doctors tend to prescribe them to people who do not get better by taking 5-ASAs.

Immunomodulators include:

  • azathioprine
  • 6-mercaptopurine, or 6-MP

People need to take them long-term, and these medicines can take up to 3 months to start working.

The drugs can cause abnormal liver function and pancreatitis. Taking immunomodulators can also put someone at higher risk of developing skin cancer or lymphoma, which is a blood cancer. People with UC will usually need to visit a doctor regularly to check for signs of these conditions.

Other possible side effects include:

  • feeling tired
  • susceptibility to infection
  • feeling and being sick

Biologic medications also work by reducing the inflammation in the gut, and people take them on a long-term basis. Doctors usually prescribe them to people whose condition does not respond to any other medications.

They include:

  • adalimumab
  • golimumab
  • infliximab

Possible side effects include:

  • susceptibility to infection
  • higher chance of developing skin cancer
  • the skin condition psoriasis

Doctors may also recommend Vedolizumab when other treatments have not been successful. Side effects can include headache, pain in the back, arms, legs or joints, and itchy skin, or a rash.

FDA Drug Approval May Make Life Easier for People with Ulcerative Colitis

People with a type of inflammatory bowel disease have a new treatment option.

The Food and Drug Administration (FDA) has expanded its approval of the drug tofacitinib (sold under the brand name Xeljanz) for adults with moderate to severe ulcerative colitis.

Tofacitinib was initially approved by the FDA in 2012 for the treatment of rheumatoid arthritis.

It will now become the first oral medication approved for chronic use in the treatment of ulcerative colitis.

Ulcerative colitis is a chronic, inflammatory bowel disease (IBD) that affects the colon. There’s no known cure and treatment options are limited.

“What works for one ulcerative colitis patient may not work for another, and some struggle with ongoing symptoms. That is why it is so critical that our patients have different treatment options available to them,” Michael Osso, president and chief executive officer of the Crohn’s & Colitis Foundation, told Healthline. “We are thrilled to have this new treatment option available to ulcerative colitis patients. Every new treatment provides new hope to our community.”

More than 900,000 people are affected by ulcerative colitis in the United States. The disease is part of a group of illnesses, including Crohn’s disease, that fall under the umbrella term of inflammatory bowel disease.

What is ulcerative colitis?

Ulcerative colitis occurs due to an abnormal response by the body’s immune system in the gastrointestinal tract, specifically the colon.

The immune system may mistake food and bacteria in the GI tract as potentially harmful foreign substances and send white blood cells to the lining of the bowels, resulting in inflammation.

The symptoms of ulcerative colitis will often be dormant (“in remission”), but become active (a “flare-up”) from time to time.

It can become progressively worse over time.

Symptoms include:

  • urgent and frequent bowel movements
  • fatigue
  • abdominal pain
  • weight loss
  • bloody stool

In severe cases, anemia may occur from blood loss.

Unlike Crohn’s disease, ulcerative colitis only affects the colon, not the entire GI tract.

Limited treatment now

Current treatments for ulcerative colitis aren’t effective in all people, hence the importance of new ones.

Even the best current treatments, drugs known as anti-TNF or TNF inhibitors, can yield lackluster results.

“They work in patients initially about 60 percent of the time… Over the following year, of the 60 percent that are responsive, as much as 30 to 50 percent may lose responsiveness,” said Dr. Brent Polk, professor of pediatrics and gastroenterology at the University of Southern California (USC).

“So, by a year they may only be effective in 30 to 40 percent of patients. As you can see, there is a huge gap in our currently best available treatment,” Polk told Healthline earlier this year.

How tofacitinib works

Tofacitinib is a Janus kinase inhibitor and works by targeting a specific cellular process in the immune response to help stop inflammation.

In three separate controlled clinical trials, the drug demonstrated effective treatment in people with moderate to severe ulcerative colitis.

In one 8-week trial, a twice daily dose of the drug induced remission in nearly 20 percent of patients by week eight.

In a longer trial, remission was achieved within one year in up to 47 percent of participants, depending on the dose they were given.

“It’s highly effective,” Dr. Edward V. Loftus Jr., a professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic in Minnesota, said while speaking on behalf of the American Gastroenterological Association.

“However, we don’t have any comparative effectiveness studies, so it’s hard to say how much more or less effective relative to other therapies,” he told Healthline.

Some cautionary words

There are several common adverse effects associated with the use of tofacitinib.

They include:

  • diarrhea
  • elevated cholesterol levels
  • herpes zoster (shingles)
  • rash
  • upper respiratory infection

The use of the drug has been specifically linked to higher incidences of shingles than other treatment options.

Loftus cautioned that some people may need to be vaccinated for shingles prior to starting tofacitinib.

It also carries a “black box warning” for serious infection that may lead to hospitalization and death, and cancer. Lymphoma and other serious malignancies have been observed in patients treated with tofacitinib.

Despite these warnings, Loftus says the drug is “a very welcome addition” to the current treatment options available for ulcerative colitis.

Treatment


Ulcerative colitis

Treating severe flare-ups

While mild or moderate flare-ups can usually be treated at home, more severe flare-ups should be managed in hospital to minimise the risk of dehydration and potentially fatal complications, such as your colon rupturing.

In hospital, you’ll be given medicine and sometimes fluids directly into a vein (intravenously).

The medicines you have will usually be a type of corticosteroid or an immunosuppressant medicine called infliximab or ciclosporin.

Ciclosporin

Ciclosporin works in the same way as other immunosuppressant medicines by reducing the activity of the immune system.

But it’s more powerful than the medicines used to treat milder cases of ulcerative colitis and starts to work much sooner (normally within a few days).

Ciclosporin is given slowly through a drip in your arm (an infusion) and treatment will usually be continuous, for around 7 days.

Side effects of intravenous ciclosporin can include:

  • an uncontrollable shaking or trembling of part of the body (a tremor)
  • excessive hair growth
  • extreme tiredness (fatigue)
  • swollen gums
  • feeling and being sick
  • diarrhoea

Ciclosporin can also cause more serious problems, such as high blood pressure and reduced kidney and liver function, but you’ll be monitored regularly during treatment to check for signs of these.

Biologic medicines

Infliximab, adalimumab, golimumab and vedolizumab are medicines that reduce inflammation of the intestine by targeting proteins the immune system uses to stimulate inflammation.

These medicines block these receptors and reduce inflammation.

They may be used to treat adults with moderate to severe ulcerative colitis if other options are not suitable or working.

Infliximab may also be used to treat children or young people aged 6 to 17 with severe ulcerative colitis.

The treatment is given for 12 months unless the medicine is not working well.

Read the full NICE guidelines on:

  • infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
  • vedolizumab for treating moderately to severely active ulcerative colitis

Infliximab

Infliximab is given as an infusion over the course of 1 to 2 hours. You’ll be given further infusions after 2 weeks, and again after 6 weeks.

Infusions are then given every 8 weeks if treatment is still required.

Common side effects of infliximab can include:

  • increased risk of infection – report any symptoms of a possible infection, such as coughs, a high temperature or a sore throat, to a GP
  • the sensation that you or the environment around you is moving (vertigo) and dizziness
  • an allergy-like reaction, causing breathing difficulties, hives and headaches

In most cases, a reaction to the medicine occurs in the first 2 hours after the infusion has finished.

But some people experience delayed reactions days, or even weeks, after an infusion.

If you begin to experience the symptoms listed above after having infliximab, seek immediate medical assistance.

You’ll be carefully monitored after your first infusion and, if necessary, powerful anti-allergy medicine, such as epinephrine, may be used.

Infliximab is not usually suitable for people with a history of tuberculosis (TB) or hepatitis B and needs to be used with caution in people with HIV or hepatitis C.

This is because there have been a number of cases where infliximab has reactivated dormant infections.

The medicine is also not recommended for people with a history of heart disease or multiple sclerosis.

Tofacitinib

Tofacitinib is a newer type of medicine for ulcerative colitis.

It also works by targeting the immune system, but does this in a different way from other medicines.

The tablets are recommended for people with moderate to severe ulcerative colitis if standard treatments or biologics have not worked or are not suitable.

Tofacitinib is not recommended for use in pregnancy. Women should use reliable contraception when taking it, and for at least 4 weeks after finishing the course.

Ulcerative Colitis Treatment Options You Should Be Aware Of

Ulcerative colitis can be unpredictable, which can make it challenging for physicians to determine whether a particular course of treatment has been effective. The main goal of treatment in UC is to reduce the signs and symptoms of ulcerative colitis by regulating the immune system, and to bring about long-term remission. While there is no cure for UC, treatment can help control symptoms so that patients can lead a fuller life. Treatment may include over-the-counter as well as prescription medications, lifestyle changes in stress management, diet and nutrition, and surgery.

Prescription medications typically include anti-inflammatory drugs, immune suppressants, and steroids. If these are not effective, (TNF)-alpha inhibitors, or “biologics,” drugs typically given to treat certain types of arthritis, may be used.

Anti-Inflammatory Medication

Anti-inflammatory medications are often given first as an ulcerative colitis treatment. Oral “5-ASA” (which stands for 5-aminosalicylates) medications such as balsalazide, mesalamine, sulfasalazine, and olsalazine can work well for people with mild to moderate ulcerative colitis.

“I would describe these as a topical lotion for the colon,” says Nana Bernasko, DNP, gastroenterology expert with the American Gastroenterological Association. When the pills reach the gut, they leave granules behind that ease the inflammation. If the colitis hasn’t traveled far up the colon, applying topical mesalamine directly to the rectum might be more effective. They can be useful as a maintenance treatment in preventing relapses. They work best in the colon and are less effective if the UC is in the small intestine.

The 5-ASAs are generally tolerated well, and they won’t keep the immune system from fighting off infections like other ulcerative colitis drugs can.

Corticosteroids such as prednisone or methylprednisolone, taken either orally or topically, are a more powerful way to reduce inflammation during flare-ups, but doctors try to wean ulcerative colitis patients off them after a few months. Steroids should not be used long-term to treat ulcerative colitis.

Over time, steroids have can have side effects that affect almost any part of the body, including weakened bones, increased blood sugar, and cataracts, says Rabia De Latour, MD, gastroenterologist and assistant professor of medicine at NYU Langone Health in New York City. “The goal with all treatment for IBD is steroid-free remission,” she says. Steroids can also weaken your immune system and make you vulnerable to infection.

Budesonide is a steroid that is used to treat localized inflammation in ulcerative colitis. Because its systemic exposure is minimal, there is a lower risk of troublesome side effects compared to other steroids.

Immune Suppressants

If aminosalicylates and corticosteroids are not effective, immune suppressants such as azathioprine and mercaptopurine may be given to suppress the immune system so that it cannot cause ongoing inflammation. These medications stop inflammation before it begins by blocking the overactive cells in the immune system that are driving inflammation. When the immune system is being suppressed, ulcerative colitis symptoms might go away, but your body could also be at higher risk of infection.

These drugs may also be effective in maintaining remission in people who haven’t responded to other medications designed to achieve remission.

Biologics

(TNF)-alpha inhibitors, or “biologics,” typically given to people with inflammatory arthritis, may be used for people with moderate to severe UC who don’t respond to or can’t tolerate the side effects of other treatments.

Biologics are more powerful and targeted immunosuppressive drugs. They’re made from living cells, not lab-made chemicals, and are delivered straight into the bloodstream through an injection or IV. Biologics are effective in ulcerative colitis about 70 to 80 percent of the time, but they’re also expensive and can “become a lifetime commitment,” says Glenn H. Englander, MD, gastroenterologist in West Palm Beach, Florida. The body can build up antibodies against biologic drugs, so the drugs might not be as effective if you stop and restart them.

These drugs, such as infliximab and adalimumab, act against a protein produced by the immune system and may be combined with other immunosuppressants.

Antibiotics and Other Ulcerative Colitis Treatment

Antibiotics including metronidazole, ampicillin, and ciprofloxacin are typically used when infection is present or when there are fistulas around the anal canal. Additional medications that are sometimes given include anti-diarrheal medications such as loperamide, iron supplements for those with chronic intestinal bleeding who are at risk for anemia, and over-the-counter pain relievers including acetaminophen. Importantly, the pain relievers ibuprofen, naproxen sodium and diclofenac sodium should not be used to treat ulcerative colitis as they can worsen symptoms and the severity of disease.

Surgery can eliminate ulcerative colitis but it typically means removal of the entire colon or rectum. Removing all or part of the rectum and colon is usually reserved for severe cases or ones presenting serious complications, says Dr. Englander. In some cases, the surgeon will remove the colon and rectum, then create a “J-pouch” from the small intestine that acts like a new rectum. Other times, the digestive systems might be connected to an external pouch that collects stool for the patients to dispose of.

Lifestyle Changes for Ulcerative Colitis

It’s also important to control stress, as it can worsen UC symptoms and may trigger ulcerative colitis flare-ups. Exercise, meditation, yoga and biofeedback, a stress-reduction technique designed to reduce muscle tension and slow heart rate via a feedback machine, are often recommended to help ulcerative colitis patients reduce stress levels.

For more information about ulcerative colitis treatment and more, visit the American Gastroenterological Association’s IBD patient resources.

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