How is ulcerative colitis treated?
As a rule, ulcerative colitis is treated with medication. As described above, a distinction is made between two types of medication. Those that are given permanently to reduce the activity of the disease (maintenance therapy) and those that are given when a relapse occurs in order to alleviate the symptoms that occur during this time as effectively as possible.
A distinction is made between drugs that have an anti-inflammatory effect and those that have an immunosuppressive effect. The latter are intended to downregulate the body’s own immune system, as it often becomes overactive in ulcerative colitis. There are drugs that can be taken in tablet form and those that are intended to act as locally as possible, rectal enemas or suppositories are used.
Painkillers are also often necessary in the treatment of ulcerative colitis. In severely affected patients, in whom no sufficient improvement can be achieved with medication, and in patients with complications, surgery may also be considered as a therapeutic option. This is possible because ulcerative colitis only affects the colon, but not the small intestine.
The colon or parts of it can therefore be removed surgically. This is a relatively time-consuming operation, as the intestinal passage must be restored by rebuilding and reconnecting the small intestine. The goal of drug therapy for ulcerative colitis is always remission, i.e. to end the disease flare-up.
It is not possible to cure the disease with medication alone. Which medication is administered depends on the severity of the symptoms. Generally, mesalazine (5-ASA, trade name e.g. Salofalk) is used for mild to moderate attacks.
Depending on which parts of the colon are affected, either in the form of suppositories, shots or foams or as tablets. The treatment is continued for at least two years after the end of the relapse to maintain remission. As an alternative, the bacterial strain E. coli Nissle (trade name Mutaflor) may be used in case of intolerance.
In the case of more severe relapses or failure of mesalazine, cortisone preparations are used, but these should only be used for a short time due to their side effects. In case of non-response the immunosuppressive drugs tacrolimus and ciclospoprin A are still available. In special cases the TNF-alpha-blockers Adalimumab, Infliximab and Golimumab are used in case of further therapy failure.
In chronically active colitis, azathioprine or 6-mercaptopurine is also used, a so-called immunomodulator which weakens the body’s immune reactions. However, this drug does not take effect until three to six months after taking it. Only since the beginning of 2014 has the integrin antagonist vedolizumab (trade name Entyvio) also been approved for the treatment of ulcerative colitis.
Cortisone preparations are among the standard drugs for treating ulcerative colitis. They are often used locally, for example as enemas or suppositories, for mild to moderate attacks of ulcerative colitis. For more severe attacks, systematic administration of cortisone is often necessary, i.e. in the form of tablets or intravenously.
Particularly with this form of administration, the risk of the occurrence of the typical side effects of cortisone (e.g. increase in blood pressure, weight gain, water retention in the tissue, increase in blood sugar, etc.) is high with long-term use, which is why cortisone is generally avoided with long-term medication. Humira® is an active ingredient from the group of biologicals.
It contains the active ingredient adalimumab. This is an antibody against a signal substance that plays an important role in the body’s own inflammatory processes. The antibody is intended to reduce their activity and thus curb the inflammatory processes.
Humira® is used as a subcutaneous injection, i.e. it is injected into the subcutaneous fatty tissue. This is usually necessary every two weeks. Humira® is used in ulcerative colitis when all other medications have not brought about sufficient improvement and when the disease is severe or moderate.
Humira® is a very expensive pharmaceutical, one syringe costs just under 1000 Euros. Anti-inflammatory drugs are used to treat an acute flare of ulcerative colitis. Two in particular should be mentioned here: Mesalazine and drugs from the corticoid/steroid group.
Mesalazine can be taken as suppositories, rectal foam or tablets, depending on which part of the colon is affected. If therapy with mesalazine is not sufficient, steroids such as budesonide are also used. This can also be administered rectally for local application.
If this is not sufficient, prednisolone tablets can be used. Long-term therapy with steroids such as prednisolone or budesonide is usually avoided because of the numerous side effects that can occur after prolonged use. If steroids have been taken for several weeks, as a rule no direct discontinuation is possible, but the medication must be discontinued.
This means that the dose is gradually reduced until the medication can be discontinued completely. If it is a severe acute attack, treatment in hospital may be necessary. Here the steroids can be administered through the vein, which often leads to a faster and more effective effect.
