Medicines that treat ulcerative colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease that causes inflammation and sores, called ulcers, in the inner lining of the colon and rectum. Treatment for ulcerative colitis depends on how severe the disease is and where it occurs in the colon.

Medicines are an important part of managing ulcerative colitis. Different types of medicine work in different ways to control inflammation, relieve symptoms and, in some cases, help the colon heal Treatments that work well for some people may not work for others, so it might take time to find an approach that helps you. Here are the main types of medications your doctor might recommend to treat ulcerative colitis.

Anti-inflammatory drugs are often the first step in treating ulcerative colitis. They calm inflammation in the colon, which in turn helps control symptoms. Examples include:

Aminosalicylates work by delivering a substance called 5-aminosalicylic acid (5-ASA) to the lining of the colon, where it helps calm inflammation. This medication can be taken by mouth as a pill or rectally as a suppository or enema. Aminosalicylates are considered some of the safest medications for mild to moderate ulcerative colitis. They reduce inflammation in the colon without weakening the body's immune system. They are also effective at inducing remission and maintaining it. Rare side effects may include headache, hair loss, kidney problems, and inflammation of the lungs or pancreas.

Corticosteroids, commonly called steroids, work quickly to suppress the immune system and reduce inflammation. Corticosteroids can be taken by mouth, by IV infusion through a vein, or rectally as an enema or suppository. Corticosteroids should only be used for a short time. Using them long-term is not safe because of possible side effects, including weight gain, mood changes, high blood sugar, bone thinning, cataracts and an increased risk of infections.

Immunomodulators reduce inflammation by quieting an overactive immune system. There are several medications within this category that treat ulcerative colitis. They are taken by mouth or IV infusion, and it usually takes a few months for them to work fully.

Your healthcare team might recommend an immunomodulator to help you taper off steroids, avoid taking steroids or when other treatments don't manage your symptoms. These medicines also are prescribed to help keep UC in remission. Immunomodulators can be taken alone or in combination with other medications to make them more effective. Since immunomodulators reduce immune activity, your healthcare team will monitor you for infections and other side effects of treatment.

Biologic medicines treat moderate to severe ulcerative colitis. Biologics are a class of protein-based medicines made from living cells rather than traditional chemical compounds. Biologic medicines are given either through an IV infusion or as an injection, and it can take weeks to notice improvement in your symptoms.

Compared with older therapies, such as corticosteroids or traditional immune suppressants, biologics are more targeted in their approach to reduce inflammation and help the colon heal. But they can still reduce your ability to fight infections. Before you begin biologic therapy, you will likely be checked for infections such as tuberculosis and hepatitis B. Your care team will also monitor you for other infections and complications throughout treatment.

There are three main types of biologic medicines to treat ulcerative colitis.

This type of biologic medicine helps calm ulcerative colitis by blocking the actions of an immune system protein called tumor necrosis factor (TNF). TNF is one of the body's strongest signaling proteins. It acts like an alarm, telling the body to ramp up immune activity and inflammation.

Blocking how TNF communicates turns down the alarm signal, reducing the immune system's response. This decreases inflammation and gives the colon a chance to heal.

Interleukins are proteins that signal the immune system to start and sustain inflammation. Interleukin blockers that treat ulcerative colitis work by targeting two of these messengers: interleukin-12 (IL-12) and interleukin-23 (IL-23).

IL-12 and IL-23 activate certain white blood cells and trigger the release of inflammatory signals. In UC, these signals become overactive and drive ongoing inflammation in the colon. Interleukin blockers work by binding to IL-12 and IL-23, preventing them from attaching to immune cells. This decreases the number of signals being released, reduces inflammation and gives the colon lining a chance to heal. Some biologics block both IL-12 and IL-23. Newer options block IL-23 only, aiming to reduce inflammation while preserving more of the immune system's other signaling pathways.

Integrins are proteins on the surface of cells that act like grips, helping cells stick to blood vessel walls and move into the body's tissues. In ulcerative colitis, integrins help inflammatory white blood cells get out of the bloodstream and into the colon wall, where they add to ongoing inflammation.

Integrin blockers reduce inflammation by limiting how many inflammatory white blood cells can move from the bloodstream into the lining of the colon. By allowing fewer inflammatory cells to reach the intestine, integrin blockers reduce inflammation, giving the intestinal lining a chance to heal.

Small molecule medicines are a newer class of oral pills that work by calming down overactive immune signals that drive inflammation in the lining of the colon. These medicines are often used to treat moderate to severe ulcerative colitis, particularly in people who have not responded to other treatments.

Small molecule medicines tend to work quickly. While most people tolerate them well, some of these medications are linked to specific risks, such as shingles, blood clots or certain cancers for some people. You may need to be checked for heart and eye conditions before treatment. As with other broad immune-targeting therapies, small molecule medicines can increase your risk of infections, making regular monitoring important.

There are two categories of small molecule medicines used to treat ulcerative colitis.

An enzyme called Janus kinase (JAK) plays a key role in producing chemicals that cause inflammation. Think of JAKs like relay switches that help pass a message along to the next step. A JAK inhibitor blocks one or more of these switches, so fewer inflammatory messages get through. This can reduce inflammation and help the lining of the colon heal.

Sphingosine 1-phosphate (S1P) is a natural signaling molecule that activates certain immune cells, especially lymphocytes. Lymphocytes and other immune cells move in and out of your lymph nodes. The signals sent from S1P molecules tell immune cells when to leave the lymph nodes and enter the bloodstream. S1P receptor modulators work by changing the signal so that more lymphocytes stay in the lymph nodes and fewer circulate to the gut to fuel inflammation.

Treatment for ulcerative colitis is highly individualized and often involves combining medications, monitoring side effects, and adding lifestyle and dietary strategies. Openly communicating with your healthcare team is key to finding the right treatment for you.