When you live with moderate to severe ulcerative colitis (UC), remission is the goal — when your symptoms aren’t active, you feel well, and you can do daily activities with ease.
You may have already tried other medicines to manage UC. These include:
- 5-aminosalicylates like mesalamine (Delzicol, Rowasa, others) and sulfasalazine (Azulfidine)
- Corticosteroids like budesonide (Uceris) and prednisone
But over time, treatments for UC have changed dramatically.
The newest generation of UC medicines can help put your disease into remission for long-term relief of symptoms.
Among these targeted medicines are the disease-modifying anti-inflammatory drugs (DMAIDs). Disease-modifying medications can change the way a condition progresses. DMAIDS like biologics and Janus kinase (JAK) inhibitors target the specific parts of the immune system that trigger inflammation.
What Are the Targeted Treatments for UC?
Some of these medicines calm your immune system to reduce the inflammation that causes your symptoms. Others target specific parts of your immune system to bring down inflammation.
DMAIDs
Understanding how each of these medicines work, how you take them, and what side effects they might cause can help you have a more informed discussion with your doctor. Which of these UC medicines your doctor recommends depends on how severe your disease is, which medicines you have taken before, and how you responded to the other medicines you’ve tried.
What Are Biologics?
Biologics are a type of DMAID. DMAIDs change the way your immune system works. They keep a disease from progressing and prevent complications. They're designed to reduce inflammation, relieve symptoms, and put UC into remission.
Biologics are made in a lab from living organisms. People with UC have higher levels of inflammatory substances than other people. These drugs work by blocking or interfering with those substances, which helps to reduce the inflammation and damage in the lining of the large intestine:
- Humira, Simponi, and Remicade block tumor necrosis factor (TNF)
- Omvoh, Skyrizi, and Tremfya block interleukin-23 (IL-23)
- Stelara blocks interleukin-12 (IL-12) and IL-23
- Entyvio blocks integrin
Biologics help put UC into remission and give the lining of your intestine time to heal. These biologics come as an injection under the skin or as an infusion into a vein.
Biosimilar drugs are almost exact copies of biologics. For example, Abrilada is one of the biosimilars to adalimumab. Renflexis is a biosimilar to infliximab. Each of these copycat medicines works in the same way as the biologic it was designed to mimic and has the same safety profile but often costs less than the biologic.
JAK inhibitors
These medicines are also DMAIDs. Rinvoq and Xeljanz are targeted small-molecule drugs. Like biologics, they treat UC by acting on parts of the immune system that cause inflammation in the intestine – in this case, a group of enzymes called Janus kinases.
Unlike biologics, JAK inhibitors come as a pill that you take once or twice a day. JAK inhibitors work quickly. They can start to reduce inflammation and improve symptoms within a couple of weeks.
All the DMAIDs calm your immune system. In doing this, they lower your body's defenses against germs, which could increase your risk for infection. Your doctor will make sure you're up-to-date on your vaccines before you start taking one of these medicines. The doctor may also test you for infections like tuberculosis and hepatitis. Biologic drugs can reawaken these infections if they're already in your body.
Learn more about DMAIDs for treating UC.
What Are Immunomodulators?
These medicines change your immune system in ways that reduce inflammation. Doctors have prescribed these medicines since the 1960s to treat inflammatory bowel disease (IBD) — UC and Crohn's disease.
Sometimes doctors prescribe immunomodulators together with biologic drugs. This may help to improve symptoms more than using either drug alone. The combination can also prevent your immune system from making antibodies against the biologic drug, which could make it less effective. These drugs are not recommended for treating UC on their own.
Conventional Immunomodulators
Thiopurines
Azathioprine (Azasan, Imuran) and 6-mercaptopurine (Purinethol, Purixan) also bring down swelling in your intestine. In addition, they can reduce your need for steroids. You take thiopurines as a pill once or twice a day.
Sphingosine 1-Phosphate (S1P) Receptor Modulators
These medicines attach to receptors called S1P on the surface of certain white blood cells called lymphocytes. They block the release of those cells into your blood so fewer of them get into your intestine. Blocking the release of these immune cells helps lower inflammation in your intestines.
Learn more about immunomodulators for treating UC.
Doctors prescribe them for people with moderate to severe ulcerative colitis who haven't improved enough on a biologic or other treatment or whose UC has stopped responding to other medicines.
When deciding on a UC medicine, talk to your doctor about your treatment goals and the benefits and risks of each drug. Here are five important things to ask about.