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Medications for ulcerative colitis vary depending on the severity of the disease
Treatment strategies for ulcerative colitis (UC) vary from person to person. Your doctor will base recommendations for medication on the intensity of your symptoms and severity of the disease. Drugs may be given as combination therapy or single drug therapy.
There are 6 types of medication used to treat UC.
- Mild to moderate
- Maintenance treatment to prevent flare-ups
Oral and rectal
- Sulfasalazine
- Mesalamine
- Olsalazine
- Balsalazide
Moderate to severely active
Oral and rectal
- Prednisone
- Prednisolone
- Methylprednisolone
- Budesonide
Prescribed when previous medications are not effective (resistant UC)
- Oral
- Application of local gel in case of tacrolimus
- Azathioprine
- 6-mercaptopurine
- Cyclosporine
- Tacrolimus
FDA-approved to treat moderate to severe
Oral
- Tofacitinib
Moderate to severe
Monthly shot or intravenous in a hospital setting
- Adalimumab
- Golimumab
- Infliximab
- Ustekinumab
- Vedolizumab
Moderate to severe
Depends on drugs used
- Infliximab-abda
- Infliximab-dyyb
- Infliximab-qbtx
If your body stops responding to medications or if you have emergency complications, you may need to undergo a surgical procedure to remove the affected part of the colon.
How do drugs used to treat ulcerative colitis work?
- Aminosalicylates (5-ASA) work in the lining of the large intestine, including the rectum, to decrease cellular inflammation and heal sores.
- Corticosteroids suppress the entire immune response instead of specific parts that cause inflammation. They act on the white blood cells (T type and the natural killer type) to reduce the chemicals that increase inflammation. Steroid use can cause side effects such as poor bone health, muscle weakness, weight gain, skin bruising skin and increased risk of infection. Because of this, these medications can’t be stopped abruptly and require medical supervision.
- Immunomodulators also suppress the immune response but may take several months to take effect, which is why they are often used when the drugs above either do not work or have only partially worked. Some immunomodulators are used to enhance the effectiveness of other medications. Immunomodulatory therapy requires monitoring, with periodic assessments of blood counts and blood tests to anticipate any negative side effects.
- Janus kinase (JAK) inhibitors block the JAK enzyme inside white cells. They prevent inflammation by reducing levels of substances called cytokines in the blood. These work well in severe cases of UC.
- Biologics and biosimilars are lab-made antibodies that stop certain proteins in the body from causing inflammation. These may be given orally or as shots and need careful medical supervision.
What causes ulcerative colitis?
UC affects the inner lining of the intestine, causing inflammation and ulcers. The disease is thought to be largely autoimmune in nature, which means your immune system malfunctions and attacks its own gut cells. Your body then produces substances that attack and damage normal intestinal cells and good gut bacteria.
While the cause of UC is unknown, suppressing the immune system can help symptoms subside and create longer periods of remission. When creating a treatment plan, your doctor will conduct thorough physical exams and blood tests to grade the disease and classify it as mild, moderate or severe. They will then prescribe medication accordingly.