Biological therapy in the treatment of moderate-to-severe ulcerative colitis patients: can colectomy be prevented?

Abstract

Ulcerative colitis treatment intends to induce remission, and its maintenance. Biological drugs, such as infliximab, have been indicated in moderate and severe cases of the disease, which are unresponsive to conventional medication. Randomized controlled trials proved the efficacy of biological treatment with high rates of sustained disease remission and mucosal healing. Recently, the concept of mucosal healing has been inversely associated with surgical treatment. Patients treated with infliximab have lower colectomy rates than those receiving conventional therapies. We suppose that earlier use of biological drugs in disease's course would lead to better clinical control and mucosal healing, with a consequent reduction in colectomy rates. To support this hypothesis, a literature review from January, 1996 to April, 2011 was performed.<br>O tratamento da colite ulcerativa tem como objetivo induzir a remissão, além da manutenção da remissão da doença. Agentes biológicos como o infliximabe têm sido indicados em casos moderados e graves da doença, os quais não respondem à medicação convencional. Ensaios clínicos randomizados comprovaram a eficácia do tratamento biológico com altas taxas de remissão da doença e cicatrização sustentada da mucosa. Recentemente, o conceito de cicatrização da mucosa tem sido inversamente associado com o tratamento cirúrgico. Pacientes tratados com infliximabe têm taxas mais baixas de colectomia se comparados com aqueles que receberam terapias convencionais. Supõe-se que quanto mais cedo for introduzida a terapia biológica no curso da doença, melhor seriam o controle clínico e a cicatrização da mucosa, com consequente redução nas taxas de colectomia. Para apoiar esta hipótese, foi realizada uma revisão da literatura entre janeiro de 1996 e abril de 2011

Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

“…In fact, the treatment pattern at baseline is in line with other studies from Latin America[19]. International guidelines recommend the use of 5-ASA compounds (especially in proctitis and left-sided UC) and/or corticosteroids (preferred in CD patients) for the induction phase and, in more severe or refractory cases, azathioprine and biological agents, while salicylates, thiopurines and biologics are usually recommended for the maintenance period[56-58].…”

Efficacy of herbal medicine (Gegen Qinlian Decoction) on ulcerative colitis

“…[9,10] In recent years, new biological agents have been shown to be effective in inducing remission in patients with moderate to severe active UC, even preventing the need for a colectomy in some cases. [11,12] However, considering the need for the long-term maintenance of UC treatment, the high financial cost of these biological therapies is a barrier for many patients. [13] Thus, conventional therapies alone may not fully meet the needs of UC patients.…”