When you have ulcerative colitis (UC), the goal of treatment is to stop your immune system from attacking the lining of your intestine. This will bring down the inflammation causing your symptoms, and put you into remission. Your doctor can choose from several different types of medications to help you achieve these goals.

In the past few years, the number of drugs used to treat UC has increased. Researchers are studying other new and possibly improved treatments in clinical trials.

A few different types of medication are available to treat UC. Your doctor will help you choose one of these therapies based on:

  • the severity of your disease (mild, moderate, or severe)
  • which drugs you’ve already taken
  • how well you responded to those medications
  • your overall health

Aminosalicylates

This group of drugs contains the ingredient 5-aminosalicylic acid (5-ASA). They include:

  • sulfasalazine (Azulfidine)
  • mesalamine (Canasa)
  • olsalazine (Dipentum)
  • balsalazide (Colazal, Giazo)

When you take these drugs by mouth or as an enema, they help bring down inflammation in your intestine. Aminosalicylates work best for mild-to-moderate UC, and can help prevent flares.

Corticosteroids

Corticosteroids (steroid drugs) suppress the immune system to bring down inflammation. Examples include:

  • prednisone
  • prednisolone
  • methylprednisolone
  • budesonide

Your doctor may prescribe one of these drugs short-term to calm a symptom flare. It’s not a good idea to stay on steroids long-term, because they can cause problems like high blood sugar, weight gain, infections, and bone loss.

Immunomodulators

These drugs suppress your immune system to prevent it from causing inflammation. You may start taking one of these medications if aminosalicylates haven’t helped your symptoms. Examples of immunomodulators include:

  • azathioprine (Azasan)
  • 6-mercaptopurine (6MP) (Purinethol)
  • cyclosporine (Sandimmune, Neoral, others)

TNF blockers

TNF blockers are a type of biologic drug. Biologics are made from genetically engineered proteins or other natural substances. They act on the specific parts of your immune system that drive inflammation.

Anti-TNF drugs block an immune system protein called tumor necrosis factor (TNF) that triggers inflammation. They can help people with moderate-to-severe UC whose symptoms haven’t improved while on other drugs.

TNF blockers include:

  • adalimumab (Humira)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • vedolizumab (Entyvio)

If the treatment you’ve tried hasn’t controlled your symptoms or stops working, you may need surgery. A procedure called proctocolectomy removes the whole colon and rectum to prevent further inflammation.

After surgery, you won’t have a colon to store wastes. Your surgeon will create a pouch outside your body called an ileostomy, or inside your body from part of your small intestine (ileum).

Surgery is a big step, but it will relieve the symptoms of UC.

In the last few years, a few new UC treatments have emerged.

Tofacitinib (Xeljanz)

Xeljanz belongs to a class of medications known as Janus kinase (JAK) inhibitors. These drugs block the enzyme JAK, which activates cells of the immune system to produce inflammation.

Xeljanz has been approved since 2012 to treat rheumatoid arthritis (RA), and since 2017 to treat psoriatic arthritis (PsA). In 2018, the FDA also approved it to treat people with moderate-to-severe UC who haven’t responded to TNF blockers.

This drug is the first long-term oral treatment for moderate-to-severe UC. Other drugs require an infusion or injection. Side effects from Xeljanz include high cholesterol, headache, diarrhea, colds, rashes, and shingles.

Biosimilars

Biosimilars are a relatively new class of drugs that are designed to mimic the effects of biologics. Like biologics, these drugs target immune system proteins that contribute to inflammation.

Biosimilars work in the same way as biologics, but they may cost much less. Four letters are added to the end of the name to help distinguish the biosimilar drug from the original biologic.

The FDA has approved several biosimilars for UC in the last few years, including:

  • infliximab-abda (Renflexis)
  • infliximab-dyyb (Inflectra)
  • infliximab-qbtx (Ixifi)
  • adalimumab-adbm (Cyltezo)
  • adalimumab-atto (Amjevita)

Researchers are constantly searching for better ways to control UC. Here are a few new treatments under investigation.

Fecal transplant

A fecal transplant, or stool transplant, is an experimental technique that places healthy bacteria from a donor’s stool into the colon of someone with UC. The idea may sound unappealing, but the good bacteria helps heal damage from UC and restore a healthy balance of germs in the gut.

Stem cell therapy

Stem cells are the young cells that grow into all of the various cells and tissues in our bodies. They have the potential to heal all kinds of damage if we harness and use them correctly. In UC, stem cells may alter the immune system in a way that helps bring down inflammation and heal damage.

Doctors have a wider range of treatment options for UC than ever before. Even with so many drugs, some people have trouble finding one that works for them.

Researchers are constantly studying new treatment approaches in clinical trials. Joining one of these studies can give you access to a drug before it’s available to the public. Ask the doctor who treats your UC if a clinical trial in your area might be a good fit for you.

The outlook for people with UC is much better today, thanks to new drugs that can calm intestinal inflammation. If you’ve tried a drug and it didn’t help you, know that other options may improve your symptoms. Be persistent, and work closely with your doctor to find a therapy that ultimately works for you.