Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD). It happens when an immune system response causes inflammation in the inner lining of the large intestine. It’s not clear what prompts this response.
Medication to reduce inflammation is the main treatment. There’s a growing list of medications approved for the treatment of UC. And biosimilars are expanding options even more.
Research into the causes and contributing factors of UC is ongoing. Scientists are looking into such topics as the microbiome, genetics, and environmental factors.
Finding the cause of UC may be the key to more effective treatments. It could also lead to strategies to prevent UC in the first place.
In this article, we’ll discuss new treatments and studies on UC and where the research is heading.
When medications don’t effectively manage UC symptoms, surgery may be the next step. This may involve removing the colon and creating an ileal-anal pouch to function in place of the rectum.
The researchers found that those who developed pouchitis had low levels of secondary bile acids in their digestive tracts. They also had low levels of Ruminococcaceae bacteria. If confirmed, this could lead to the development of supplements to provide the missing gut microbes or restore the bacteria that produce them.
A 2021 study highlighted bacterial changes in the gut prior to developing UC. With further research, doctors may be able to identify people at risk of UC. This could pave the way for precision drugs designed to prevent UC.
Other avenues of research into the causes of UC include:
- environmental factors
- lifestyle factors such as smoking, diet, and exercise
Ongoing research in treatment options includes:
- fecal microbiota transplantation (FMT)
- stem cell therapy
There are currently dozens of medications to treat UC. Your doctor may prescribe one or more of the following:
- Aminosalicylates (5-ASA). These medications are taken orally or rectally to reduce inflammation in the lining of the gastrointestinal tract. They’re effective at treating mild-to-moderate UC flares.
- Corticosteroids. For moderate-to-severe UC, your doctor may prescribe corticosteroids. They suppress the immune system response. Corticosteroids should not be used long-term due to the risk of side effects.
- Immunosuppressants. This class of medications suppresses the immune system to help reduce inflammation. Your doctor may prescribe immunosuppressants if aminosalicylates and corticosteroids have not been effective.
- Biologics. Biologic medications are used to treat people with moderate-to-severe UC. They target specific proteins in the body that cause inflammation.
- Biosimilars. A biosimilar drug is nearly identical to an existing Food and Drug Adminstration (FDA)-approved biologic medication.
- Janus kinase (JAK) inhibitors. JAK inhibitors block an enzyme involved in triggering inflammation.
Several UC medications have been approved in the past couple of years.
Medications approved in 2021 include:
- Ozanimod (Zeposia). This medication is for adults with moderate-to-severe UC. It’s the first oral sphingosine 1-phosphate (S1P) receptor modulator approved for UC. Results of
phase 2and phase 3 clinical trials suggest it’s an effective first-line and maintenance therapy. It was also generally well tolerated.
- Adalimumab (Humira). Adalimumab is a type of biologic called a tumor necrosis factor (TNF) blocker. It was approved for UC in 2012. In 2021, it became the first subcutaneous biologic treatment approved for people ages 5 and up with moderate-to-severe UC. Phase 3 clinical trials demonstrated clinically meaningful rates of remission and response in children.
- Adalimumab-adbm (Cyltezo). This is a biosimilar
approvedfor adults with moderate-to-severe UC.
Medications approved in 2020 include:
- Adalimumab-fkjp (Hulio). This is a biosimilar approved for adults with moderate-to-severe UC who have had an inadequate response to other therapy.
- Infliximab-axxq (Avsola). A biosimilar, infliximab-axxq is a treatment option approved for adults with moderate-to-severe UC who’ve had an inadequate response to other therapy.
Clinical trials study the safety and effectiveness of new treatments. Enrolling in a trial can give you access to treatments that aren’t yet available anywhere else. Your doctor can help you locate clinical trials and assess your eligibility.
These are just a few of the clinical trials for UC that are currently enrolling:
- The Role of Secondary Bile Acids in Intestinal Inflammation. The goal of this trial is to determine whether ursodeoxycholic acid can reduce inflammatory markers and improve quality of life in people with pouchitis.
- A Cohort Study Comparing IFX to CS for Moderate to Severe UC (INSURE). This study will compare the efficacy and safety of the biologic infliximab to corticosteroids when used as first-line therapy.
- Adherence of a 1.600 mg Single Tablet 5-ASA Treatment of Ulcerative Colitis (EASI). The EASI trial will investigate whether a simpler treatment regimen for 5-ASA improves adherence while preserving remission rates versus conventional therapy.
- Adipose Mesenchymal Stem Cells (AMSC) for Treatment of Ulcerative Colitis (AMSC_UC). This trial will evaluate the safety and efficacy of intracolonic injections of AMSCs in people with moderate UC. Recent research shows mesenchymal stem cells may have anti-inflammatory properties.
You can learn more about these and other clinical trials at clinicaltrials.gov.
In the search for a cause of UC, studies have identified at least
Healthcare technology may also advance treatment for UC. Digital apps and biosensors are hot topics in research.
In an article published in 2020, researchers described a wearable, noninvasive device that monitors sweat for inflammatory biomarkers. The researchers hypothesize that tracking inflammation may help identify IBD flare-ups. It could also let doctors know if the current therapy is working.
Per the Crohn’s & Colitis Foundation, IBD research gaps that should be prioritized include:
- non-invasive detection and monitoring of active inflammation and assessment of treatment response
- mucosal targeted drug delivery systems
- prevention of post-operative septic complications and treatment of fistulizing complications
The outlook for people with UC is better today than ever before. This is largely due to newer medications that help control inflammation in the colon. A wider choice of medications means that if your treatment isn’t working, you have other options.
As researchers learn more about the causes of UC, we can expect new advances in treatment. Identifying risk factors may also help doctors prevent UC from developing.
Research is advancing at a rapid pace. So, there’s plenty of reason for hope.
If you have UC, talk with your doctor about the latest findings and how they might affect your treatment.