Ulcerative Colitis: Current and Future Treatment Strategies

Abstract

Since the incidence of inflammatory bowel diseases including ulcerative colitis is continuously increasing worldwide, there is a strong need for effective treatment strategies. However, there is no therapy allowing for healing ulcerative colitis; consequently, the available medications will have to be applied at their best. The preferred option for mild pan- or left-sided colitis is still mesalazine. One can only emphasize that the formulations allowing for once daily dosing are not only equally effective, but even facilitate the implication of long-term therapy in daily life. In case steroids are frequently required to control disease, further immunosuppressive therapy should be introduced in order to minimize steroid exposure. Thiopurines represent the first-choice immunosuppressive medication. In more severe cases, early escalation to combinatory therapies with anti-TNF antibodies should be considered with the possibility of therapy deescalation after induction of remission. Major difficulties arise with steroid-refractory acute flares. Here cyclosporine as well as anti-TNF strategies can be initiated. However, in case of severe disease, the high 1-year colectomy rate of about 50% should be considered. If short-term surgery is an option due to disease severity, cyclosporine might be advantageous since the half-life is short compared to infliximab or adalimumab. The central problem of all therapeutic approaches is that because we chase after the disease, solid markers that allow for prediction of the future disease course are desirable. In fact, the CD8+ transcriptome might fill this gap and will potentially lead to the classification of patients in low- and high-risk groups.

Telmisartan decreases inflammation by modulating TNF-α, IL-10, and RANK/RANKL in a rat model of ulcerative colitis

“…A systematic review by Molodecky et al [1] found that highest prevalence was found in Europe (UC, 505 per 100,000 persons) and North America (UC, 249 per 100,000 persons). The therapy of choice for colitis is mesalazine and sulfasalazine is used for maintenance [2]. However, the safety of sulfasalazine decays in patients with known tolerance, and it can cause unwanted effects on male infertility [3].…”

An EGFR Targeted PET Imaging Probe for the Detection of Colonic Adenocarcinomas in the Setting of Colitis

“…Immunohistochemical (IHC) analysis was performed on CT26 tumor allografts, and colon tissue samples as described previously1, 7. Briefly, unstained 5 μm sections were cut, deparaffinized and rehydrated by standard techniques before antigen retrieval in EDTA buffer.…”

“…Inflammatory bowel disease (IBD), which consists of Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition that results from dysregulation of the mucosal immune system in the gastrointestinal tract1. The incidence of IBD is increasing, and 1.4 million people in the United States and 2.2 million people in Europe are affected by the disease2.…”

Bortezomib protects against dextran sulfate sodium-induced ulcerative colitis in mice

“…However, the majority of these drugs frequently led to multiple adverse events and exhibit limited benefits in long-term disease control (4). SASP is able to cause unwanted effects on male fertility (5) and prolonged or high-dose corticosteroid therapy is associated with hypertension, osteoporosis and immunodeficiency (6).…”