Recent Advances and Emerging Therapies in the Non-surgical Management of Ulcerative Colitis

Overview

Journal F1000Res

Specialties Biomedical Engineering
Science

Date 2018 Aug 24

PMID 30135722

Citations 25

Authors

Jan Wehkamp

Eduard F Stange

Affiliations

Soon will be listed here.

Abstract

The so-called "biologicals" (monoclonal antibodies to various inflammatory targets like tumor necrosis factor or integrins) have revolutionized the treatment of inflammatory bowel diseases. In ulcerative colitis, they have an established role in inducing remission in steroid-refractory disease and, thereafter, maintaining remission with or without azathioprine. Nevertheless, their limitations are also obvious: lack of primary response or loss of response during maintenance as well as various, in part severe, side effects. The latter are less frequent in anti-integrin treatment, but efficacy, especially during induction, is delayed. New antibodies as well as small molecules have also demonstrated clinical efficacy and are soon to be licensed for ulcerative colitis. None of these novel drugs seems to be much more effective overall than the competition, but they provide new options in otherwise refractory patients. This increasing complexity requires new algorithms, but it is still premature to outline each drug's role in future treatment paradigms.

Citing Articles

Anti-inflammatory activity of collagen peptide in vitro and its effect on improving ulcerative colitis.

Xin X, Zhou J, Liu G, Zhang M, Li X, Wang Y NPJ Sci Food. 2025; 9(1):1.

PMID: 39747094 PMC: 11697389. DOI: 10.1038/s41538-024-00367-7.

Integrative biomarker discovery and immune profiling for ulcerative colitis: a multi-methodological approach.

Jiang L, Zhang S, Jiang C, Chen H, Huang J, Yang J Sci Rep. 2024; 14(1):24290.

PMID: 39414957 PMC: 11484944. DOI: 10.1038/s41598-024-75797-0.

Efficacy and safety of Xileisan combined with mesalazine for ulcerative colitis: A meta-analysis and trial sequential analysis.

Yang X, Yu Y, Tong K, Hu G, Yu R, Su L World J Clin Cases. 2024; 12(21):4703-4716.

PMID: 39070843 PMC: 11235487. DOI: 10.12998/wjcc.v12.i21.4703.

Efficacy and safety of gut microbiota-based therapies in autoimmune and rheumatic diseases: a systematic review and meta-analysis of 80 randomized controlled trials.

Zeng L, Yang K, He Q, Zhu X, Long Z, Wu Y BMC Med. 2024; 22(1):110.

PMID: 38475833 PMC: 10935932. DOI: 10.1186/s12916-024-03303-4.

Medicinal Plants, Phytochemicals and Regulation of the NLRP3 Inflammasome in Inflammatory Bowel Diseases: A Comprehensive Review.

Direito R, Barbalho S, Figueira M, Minniti G, de Carvalho G, de Oliveira Zanuso B Metabolites. 2023; 13(6).

PMID: 37367886 PMC: 10305268. DOI: 10.3390/metabo13060728.

References

Ponte A, Pinho R, Fernandes S, Rodrigues A, Alberto L, Silva J . Impact of Histological and Endoscopic Remissions on Clinical Recurrence and Recurrence-free Time in Ulcerative Colitis. Inflamm Bowel Dis. 2017; 23(12):2238-2244. DOI: 10.1097/MIB.0000000000001275. View

Hundorfean G, Chiriac M, Mihai S, Hartmann A, Mudter J, Neurath M . Development and Validation of a Confocal Laser Endomicroscopy-Based Score for In Vivo Assessment of Mucosal Healing in Ulcerative Colitis Patients. Inflamm Bowel Dis. 2017; 24(1):35-44. DOI: 10.1093/ibd/izx012. View

Panaccione R, Ghosh S, Middleton S, Marquez J, Scott B, Flint L . Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology. 2014; 146(2):392-400.e3. DOI: 10.1053/j.gastro.2013.10.052. View

Amiot A, Grimaud J, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X . Effectiveness and Safety of Vedolizumab Induction Therapy for Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2016; 14(11):1593-1601.e2. DOI: 10.1016/j.cgh.2016.02.016. View

Reinisch W, Sandborn W, Hommes D, DHaens G, Hanauer S, Schreiber S . Adalimumab for induction of clinical remission in moderately to severely active ulcerative colitis: results of a randomised controlled trial. Gut. 2011; 60(6):780-7. DOI: 10.1136/gut.2010.221127. View

Brandse J, van den Brink G, Wildenberg M, van der Kleij D, Rispens T, Jansen J . Loss of Infliximab Into Feces Is Associated With Lack of Response to Therapy in Patients With Severe Ulcerative Colitis. Gastroenterology. 2015; 149(2):350-5.e2. DOI: 10.1053/j.gastro.2015.04.016. View

Yamamoto T, Shimoyama T, Umegae S, Matsumoto K . Endoscopic score vs. fecal biomarkers for predicting relapse in patients with ulcerative colitis after clinical remission and mucosal healing. Clin Transl Gastroenterol. 2018; 9(3):136. PMC: 5862153. DOI: 10.1038/s41424-018-0006-7. View

Roblin X, Marotte H, Rinaudo M, Del Tedesco E, Moreau A, Phelip J . Association between pharmacokinetics of adalimumab and mucosal healing in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2013; 12(1):80-84.e2. DOI: 10.1016/j.cgh.2013.07.010. View

Eriksson C, Rundquist S, Cao Y, Montgomery S, Halfvarson J . Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study. Gut. 2018; 68(4):623-632. DOI: 10.1136/gutjnl-2017-315521. View

10.

Olivera P, Spinelli A, Gower-Rousseau C, Danese S, Peyrin-Biroulet L . Surgical rates in the era of biological therapy: up, down or unchanged?. Curr Opin Gastroenterol. 2017; 33(4):246-253. DOI: 10.1097/MOG.0000000000000361. View

11.

Feagan B, Rutgeerts P, Sands B, Hanauer S, Colombel J, Sandborn W . Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013; 369(8):699-710. DOI: 10.1056/NEJMoa1215734. View

12.

Sandborn W, Feagan B, Marano C, Zhang H, Strauss R, Johanns J . Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2013; 146(1):85-95. DOI: 10.1053/j.gastro.2013.05.048. View

13.

Ma C, Guizzetti L, Panaccione R, Fedorak R, Pai R, Parker C . Systematic review with meta-analysis: endoscopic and histologic placebo rates in induction and maintenance trials of ulcerative colitis. Aliment Pharmacol Ther. 2018; 47(12):1578-1596. DOI: 10.1111/apt.14672. View

14.

Schmidt K, Muller N, Dignass A, Baumgart D, Lehnert H, Stange E . Long-term Outcomes in Steroid-refractory Ulcerative Colitis Treated with Tacrolimus Alone or in Combination with Purine Analogues. J Crohns Colitis. 2015; 10(1):31-7. DOI: 10.1093/ecco-jcc/jjv175. View

15.

Cohen S, Radominski S, Gomez-Reino J, Wang L, Krishnaswami S, Wood S . Analysis of infections and all-cause mortality in phase II, phase III, and long-term extension studies of tofacitinib in patients with rheumatoid arthritis. Arthritis Rheumatol. 2014; 66(11):2924-37. DOI: 10.1002/art.38779. View

16.

Feagan B, Rubin D, Danese S, Vermeire S, Abhyankar B, Sankoh S . Efficacy of Vedolizumab Induction and Maintenance Therapy in Patients With Ulcerative Colitis, Regardless of Prior Exposure to Tumor Necrosis Factor Antagonists. Clin Gastroenterol Hepatol. 2016; 15(2):229-239.e5. DOI: 10.1016/j.cgh.2016.08.044. View

17.

Stange E, Wehkamp J . Recent advances in understanding and managing Crohn's disease. F1000Res. 2017; 5:2896. PMC: 5271584. DOI: 10.12688/f1000research.9890.1. View

18.

Endo K, Onodera M, Shiga H, Kuroha M, Kimura T, Hiramoto K . A Comparison of Short- and Long-Term Therapeutic Outcomes of Infliximab- versus Tacrolimus-Based Strategies for Steroid-Refractory Ulcerative Colitis. Gastroenterol Res Pract. 2016; 2016:3162595. PMC: 4745932. DOI: 10.1155/2016/3162595. View

19.

Yarur A, Jain A, Sussman D, Barkin J, Quintero M, Princen F . The association of tissue anti-TNF drug levels with serological and endoscopic disease activity in inflammatory bowel disease: the ATLAS study. Gut. 2015; 65(2):249-55. DOI: 10.1136/gutjnl-2014-308099. View

20.

Carbonnel F, Colombel J, Filippi J, Katsanos K, Peyrin-Biroulet L, Allez M . Methotrexate Is Not Superior to Placebo for Inducing Steroid-Free Remission, but Induces Steroid-Free Clinical Remission in a Larger Proportion of Patients With Ulcerative Colitis. Gastroenterology. 2015; 150(2):380-8.e4. DOI: 10.1053/j.gastro.2015.10.050. View