When you live with moderate to severe ulcerative colitis (UC), remission is the goal – when your symptoms aren’t active, you feel well, and you can do daily activities with ease. How to get that relief has changed over the years. In the early 1900s, doctors prescribed bed rest and flushing out the colon to treat UC. Years later, corticosteroids came along.
While these newer medicines are good at reducing the inflammation that triggers UC symptoms, they also cause a lot of side effects.
Today, more targeted medicines have transformed the treatment of moderate to severe UC. Immunomodulators calm the overactive immune system and stop it from causing inflammation. An immune system in overdrive is the cause of UC and its symptoms.
Among these targeted medicines are the disease-modifying anti-inflammatory bowel disease drugs (DMAIDs). Disease-modifying medications change the way a condition progresses. DMAIDS like biologics and Janus kinase (JAK) inhibitors target the specific parts of the immune system that trigger inflammation. The new generation of UC medicines can help put your disease into remission and keep your symptoms under control long-term.
You may have already tried other medicines to manage UC. These include:
- 5-aminosalicylates like mesalamine (Delzicol, Rowasa, others) and sulfasalazine (Azulfidine)
- Corticosteroids like budesonide (Uceris) and prednisone
What Are the Targeted Treatments for UC?
Some of these medicines calm your immune system to reduce the inflammation that causes your symptoms. Others target specific parts of your immune system to bring down inflammation.
DMAIDs
Understanding how each of these medicines work, how you take them, and what side effects they might cause can help you have a more informed discussion with your doctor. Which of these UC medicines your doctor recommends depends on how severe your disease is, which medicines you’ve taken before, and how you responded to the other medicines you’ve tried.
What Are Biologics?
Biologics belong to a group of medicines called disease-modifying anti-inflammatory bowel disease drugs (DMAIDs). DMAIDs change the way your immune system works. They're designed to reduce inflammation, relieve symptoms, and put UC into remission.
Biologics are made in a lab from proteins and other living substances. People with UC have higher levels of these substances than other people. These drugs work by blocking those substances, which helps to reduce the inflammation and damage in the lining of the large intestine:
- Humira, Simponi, and Remicade block tumor necrosis factor (TNF)
- Omvoh, Skyrizi, and Tremfya block interleukin-23 (IL-23)
- Stelara blocks interleukin-12 (IL-12) and IL-23
- Entyvio blocks integrin
Biologics help put UC into remission and give the lining of your intestine time to heal. All biologics come as an injection under the skin or as an infusion into a vein.
Biosimilar drugs are almost exact copies of biologics. For example, Abrilada is one of the biosimilars to adalimumab. Renflexis is a biosimilar to infliximab. Each of these copycat medicines works in the same way as the biologic it was designed to mimic and has the same safety profile but often costs less than the biologic.
JAK inhibitors
These medicines are also DMAIDs. Rinvoq and Xeljanz are targeted small-molecule drugs. Like biologics, they treat UC by acting on parts of the immune system that cause inflammation in the intestine – in this case, a group of enzymes called Janus kinases.
Unlike biologics, JAK inhibitors come as a pill that you take once or twice a day. JAK inhibitors work quickly. They can start to reduce inflammation and improve symptoms within a couple of weeks.
All the DMAIDs calm your immune system. In doing this, they lower your body's defenses against germs, which could increase your risk for infection. Your doctor will make sure you're up-to-date on your vaccines before you start taking one of these medicines. The doctor may also test you for infections like tuberculosis and hepatitis. Biologic drugs can reawaken these infections if they're already in your body.
Learn more about DMAIDs for treating UC.
What Are Sphingosine 1-Phosphate (S1P) Receptor Modulators?
These medicines attach to receptors called S1P on the surface of certain white blood cells called lymphocytes. They block the release of those cells into your blood so fewer of them get into your intestine. Blocking the release of these immune cells helps lower inflammation in your intestines.
Doctors prescribe them for people with moderate to severe ulcerative colitis who haven't improved enough on a biologic or other treatment or who have stopped responding to other medicines.
What Are Immunomodulators?
These medicines change your immune system in ways that reduce inflammation. Doctors have prescribed these medicines since the 1960s to treat inflammatory bowel disease (IBD) — UC and Crohn's disease.
Sometimes doctors prescribe immunomodulators together with biologic drugs. This may help to improve symptoms more than using either drug alone. The combination can also prevent your immune system from making antibodies against the biologic drug, which could make it less effective.
Cyclosporine
This medicine calms the immune system to prevent organ rejection in people who've had an organ transplant. Cyclosporine (Neoral, Sandimmune) also reduces inflammation in the intestines. Doctors sometimes prescribe it with other UC medicines to help the medicine work better. You take cyclosporine as a pill.
Thiopurines
Azathioprine (Azasan, Imuran) and 6-mercaptopurine (Purinethol, Purixan) also bring down swelling in your intestine. And they can reduce your need for steroids. You take thiopurines as a pill once or twice a day.
Learn more about immunomodulators for treating UC.
5 Things to Consider When Choosing a Medication Treatment for UC
When deciding on a UC medicine, talk to your doctor about your treatment goals and the benefits and risks of each drug. Here are five important things to ask about.
Past treatments. Today, treatment for moderate to severe UC often starts with a biologic drug. If you don't get better on a biologic or it stops working for you, then your doctor might put you on a different biologic, add another medicine, or switch you to a different type of drug like an S1P receptor modulator.
Preexisting conditions. It's not safe for people with certain conditions to take some UC medicines. For example, some people with heart failure may not be able to use Remicade. That's because people with heart failure in studies had a higher risk of serious heart problems when they took this medicine.
Delivery method. Some treatments for moderate to severe UC come as injections or infusions. Others are pills. If you don't like needles, you might prefer to take an oral drug. But if you'd rather not take medicine every day, an infusion or injection could be a better choice.
Side effects. Each UC medicine has its own list of side effects. Some are more serious than others. Go over all the side effects with your doctor when discussing your options.
Monitoring. You may need to have certain tests while you're on the medicine. Your doctor might check you for infections or do regular blood tests to make sure the drug hasn't damaged your liver or other organs.