Ulcerative Colitis Blog

Marylou wrote into the blog asking about medical treatment for ulcerative colitis that is no longer responding to imuran, prednisone, methotrexate, or sulfasalazine. For patients seeking the next line of medical therapy, the agents of choice would be the so-called "biologics" such as Remicade. Two studies called ACT 1 & ACT 2 (Active Ulcerative Colitis Trials) were published in 2005 examining the efficacy of Remicade as a maintenance therapy for UC patients losing response to their current medications. Of the 364 patients enrolled in the studies, 65-70% had a clinical response to Remicade as compared to 29-37% of those who received placebo. Remicade is given as a 2 hour infusion at an infusion clinic or hospital. Initially, a patient receives doses at 1,2, and 6 weeks to build up the medication in the body. Thereafter, it is typically given every 8 weeks.

Another drug in the same category as Remicade is Humira. Its mechanism of action is similar to Remicade, however, it is a "humanized form" (Remicade is made from a combination of mouse and human antibodies and Humira is made from human antibodies). Humira has usually been reserved as a second line agent for people who fail Remicade therapy. It is administered as an injection done under the skin every 2 weeks.

There are several new treatments for IBD that are in the process of being developed. Many large centers and those affiliated with university hospitals can provide patients an option to try new therapies through being in a clinical trial. Patients considering this avenue can contact regional centers to find out if they may qualify to participate in a study.

Marylou also asked about the prospect of surgery in UC. The indications for surgery would include disease refractory to medicines, acute massive bleeding that cannot be stopped, a sick colon that perforates (break open), or cancer. Historically, is has been quoted that 30% of patients who develop severe disease will ultimately require a colectomy. Advances in surgical techniques over the last several decades have provided surgeons with a way to reconnect the small bowel to the rectum after the colon is removed, so appropriate UC patients may not need to wear a permanent ostomy (bag for stool collection). Surgery is a viable and reasonable option for patients suffering from porly controlled disease or ill-toward effects of medications. Patients considering surgery should seek consultation with a colorectal surgeon who is familiar with surgical techniques in IBD patients.