Introduction
Ulcerative colitis is initially treated with drugs both in the non-inflammatory phase and in the acute inflammatory phase. The choice of medication depends on the cause of the therapy and the severity of the disease. The fact that there are different groups of drugs with varying degrees of anti-inflammatory effect means that the therapy can be tailored to individual needs. By combining the drugs, the therapy can be adjusted accordingly if a single medication does not have sufficient effect.
What groups of drugs are there?
The drugs used in ulcerative colitis can be divided into three major groups. There are the so-called aminosalicylates, which are also called 5-ASA preparations, glucocorticoids and the large group of immunosuppressants. Furthermore, it must be distinguished whether the drugs are used to treat an acute attack or to maintain the inflammation-free interval.
Salofalk® (mesalazine) is the most frequently used drug in the group of aminosalicylates. It can be used to maintain the non-inflammatory phase as well as for mild to moderate relapses. Glucocorticoids, such as the drug budesonide, are used either locally as suppositories or through the vein for stronger attacks.
Due to the many side effects of glucocorticoids, including cortisone, glucocorticoid therapy should only be used for limited periods of time and is therefore not suitable for maintaining the inflammation-free phase. Lastly, there are the immunosuppressive drugs. This group includes various drugs and also antibodies that regulate the inflammatory reaction in the body.
Two of the immunosuppressive drugs can be used in maintenance therapy. These are azathioprine, a drug that downregulates DNA synthesis, and the antibody Remicarde®. Otherwise, the immunosuppressive drugs are more likely to be used in the therapy of a severe relapse.
Salofalk® is also called mesalazine and belongs to the group of aminosalicylates. It has an anti-inflammatory effect in the intestine and down-regulates the immune system. Salofalk® can be administered in various forms.
Tablets are specially coated so that they reach further down the intestinal tract and still have an effect there. This is important because ulcerative colitis typically shows an affection of the rectum, which then spreads continuously upwards. Salofalk® in the form of a suppository or as a foam preparation can therefore also reach the affected regions well.
Salofalk® is used both in the treatment of relapses, especially mild relapses, and as a maintenance therapy during the inflammation-free phase. As with any other drug, allergic reactions can occur when taking Salofalk®. These can manifest themselves with skin rashes or even fever and breathing difficulties.
In addition, in rare cases the drug can lead to a decrease in white blood cells, which can lead to serious infections. Therefore, a blood sample with blood count after a certain time is useful if the drug has been reapplied. If there is pain in the mouth or throat area and a deterioration in the patient’s state of health is perceived, the use of Salofalk® should be stopped.
Remicarde® is the trade name of an antibody Infliximab, which is directed against the tumor necrosis factor alpha. This tumor necrosis factor alpha plays an important role in the inflammatory reaction. By inhibiting this factor through Remicarde®, the inflammatory reaction can be inhibited.
Remicarde® is used in ulcerative colitis only when there is a severe relapse and in rare cases as a maintenance therapy. The reason for this is that the antibody has a number of limitations and side effects. Surgical therapy should be discussed before using Remicarde®, as well as other drugs that may only be used in severe relapses.
Remicarde® should not be given to pregnant women or patients on immunosuppressive therapy. Infections also speak against the use of the antibody. These include acute infections, but also chronic infections, such as tuberculosis.
This could be reactivated. Remicarde® must not be used in cases of cancer or severe heart disease that are associated with reduced pumping capacity.Side effects include flu-like symptoms such as headache, aching limbs and fever. The antibody can have a negative effect on all blood cells, so that exhaustion, frequent infections and spontaneous bleeding must be expected.
Cortisone belongs to the group of glucocorticoids. It is also similar to cortisone, which is produced by the body. Like Salofalk® it can either be taken as a tablet or used in the form of a foam.
Cortisone is an important drug for the therapy of relapses, as it has an anti-inflammatory effect. If the effect of the tablets or local therapy is not sufficient, cortisone can be administered via the vein, which has a better effect. It is important that cortisone should only be given for a limited period of time, otherwise the side effects will outweigh the effects. The classic therapy scheme is a short high-dose administration of cortisone (cortisone shot) followed by a slow release of the drug.
