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Treatment of ulcerative colitis

Blonski, Wojciecha; Buchner, Anna M.b; Lichtenstein, Gary R.b

Current Opinion in Gastroenterology: January 2014 - Volume 30 - Issue 1 - p 84–96
doi: 10.1097/MOG.0000000000000031
LARGE INTESTINE: Edited by Ciaran P. Kelly

Purpose of review: Ulcerative colitis is a chronic inflammatory disease of the colon of unknown cause that is characterized by alternating intervals of active and inactive disease in 80–90% of patients. The primary goal of treatment is to induce and maintain remission using therapy tailored to the individual patient. The purpose of this review was to describe the management of ulcerative colitis with emphasis on the use of anti-tumor necrosis factor (TNF) agents.

Recent findings: Recent research has shown that new anti-TNF agents, adalimumab (ADA) and golimumab, are effective in induction of remission and maintenance of remission in patients with extensive ulcerative colitis. In a recent study, infliximab was found to have comparable efficacy to cyclosporine in treatment of acute severe refractory to corticosteroids ulcerative colitis.

Summary: Anti-TNF therapy should be initiated in patients with acute severe refractory to corticosteroids ulcerative colitis and in patients with moderate-to-severe ulcerative colitis who are not responsive to conventional treatment with aminosalicylates, corticosteroids and immune modulators. Alternatives to infliximab are ADA and golimumab. Future research is needed to further assess the long-term efficacy and safety of ADA and golimumab in ulcerative colitis.

aDepartment of Internal Medicine, United Health Services, Johnson City, New York

bDivision of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Gary R. Lichtenstein, MD, Professor of Medicine, Department of Medicine, Gastroenterology Division, Perelman School of Medicine of the University of Pennsylvania, Hospital of the University of Pennsylvania, 9 Penn Tower, 1 Convention Avenue, Philadelphia, Pennsylvania 19104-4283, USA. Tel: +1 215 662 4310; fax: +1 215 349 5915; e-mail: grl@uphs.upenn.edu

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins