Managing Your Meds: Pros and Cons of UC Therapies
While ulcerative colitis (UC) affects a whopping one million-plus people in the United States, there are just four main therapies prescribed to treat the inflammatory bowel disease. The treatment you receive—corticosteroids, mesalamines, immunomodulators and biologics—all depends on the level of active UC and inflammation in your gut. Each therapy is different in how it gets you to the end goal of a calm digestive system. Click through to get the scoop on the therapy types.
Anti-Inflammatory Drugs: What Do They Do?
Anti-inflammatory drugs, like mesalamine (Lialda), work best for mild cases of UC. “These drugs have anti-inflammatory properties to help calm inflammation in the GI tract,” says Mona Rezapour, M.D., a gastroenterologist in West Hills, California, affiliated with Ronald Reagan UCLA Medical Center. Corticosteroids are another type of anti-inflammatory that's reserved for severe cases. Anti-inflammatories are usually taken orally and target the colon, where UC is typically the most active.
Anti-Inflammatory Drugs: Pros
For preventing relapse of UC symptoms, anti-inflammatories are one of the safest treatment options, says Dr. Rezapour. “These medications do not suppress the immune system," she says. "Rather they prevent the formation of pro-inflammatory factors.” Plus, taking these drugs orally is super easy and doesn’t require too much effort or in-office time on your part. These drugs can help you maintain remission (no tummy aches, no urgency, no bloody bowel movements) by simply reducing the inflammation in your gut.
Anti-Inflammatory Drugs: Cons
Since they are so effective, anti-inflammatories are typically taken for a long period of time to maintain lower levels of inflammation. (The exception to this is with corticosteroids which are only used for a short time during induction). Because the other anti-inflammatories are such long-term drugs, yearly blood tests—which can be easy to forget about—are needed to track any side effects happening in your body. The other kicker? Some of the side-effects of these drugs—headache, nausea, abdominal pain, and cramping—mimic UC symptoms. For that reason, it can be hard to tell if symptoms are active disease or just a side effect. Make sure you’re chatting with your GI regularly to tell the difference.
Immune System Suppressors: What Do They Do?
Immune system suppressors are the next step up from anti-inflammatory drugs. They're taken orally or via weekly injections to treat mild to moderate UC. Some regularly prescribed immunosuppressant drugs include: Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan)- These common drugs require regular blood work and monitoring of side effects Cyclosporine (Gengraf, Neoral, Sandimmune)-This is a go-to for people who haven't responded well to other meds. Tofacitinib (Xeljanz)- This works by blocking the inflammation process.
Immune System Suppressors: Pros
Immunomodulators reduce or eliminate the need for steroids, “because they have anti-inflammatory and immunosuppressive properties that reduce inflammation and can be used as maintenance therapy," says Dr. Rezapour. Plus, these therapies can keep you in remission, with no symptoms or side-effects, when other anti-inflammatory therapies don’t work.
Immune System Suppressors: Cons
Immunomodulators are considered maintenance therapy and can be used long term, but they can take anywhere from three to six months to start working. You do have to taper off immunomodulators when they’re being used with biologics (see next slide), and that process can take up to a year, according to Dr. Rezapour.
Biologics: What Do They Do?
Biologics are recommended for UC patients dealing with moderate to severe symptoms, like very frequent bowel movements and persistent pain that makes it difficult to get through the day. Biologics are totally different from the other therapies because they’re the only protein-based therapy for UC. How do they work? The proteins target specific areas of the immune system to stop inflammation-causing antibodies from forming in the body so there’s no more pain in your gut. Biologics are typically administered via an infusion at your doctor’s office or self-injection.
While blocking those irksome inflammation-causing proteins, biologics can help reduce steroid use by decreasing spontaneous colonic inflammation, says Dr. Rezapour. Biologics are also recommended to help reduce fistulas, which are painful passages that occur between your skin and your anus. The best part? Biologics are a great therapy to help you achieve remission and maintain it long term.
You have to be very patient with biologics. It can take a few infusions or injections before you start to respond and see results. Infusions of biologics are also known to be pretty tiresome and most UC patients end up taking a nap and some Benadryl to avoid any allergic reactions post-infusion. The other big downside is that some biologics might introduce a psoriasis-like skin condition that happens to some patients and it can remain as long as you’re on the biologic or it can go away with treatment (it’s unpredictable like that).
How to Choose
While it might seem overwhelming to decide which therapy type is best for you and your UC, your gastroenterologist is there to help you figure it out. As a team you’ll take into consideration your symptoms, how you’re feeling, and what your goals are for managing your UC and then he or she will make a recommendation based on what’s best for you. Your therapies might change over time, and that’s totally ok. Because UC is a chronic condition, with no known cure, you will probably be on some form of these therapies for the rest of your life. You should never stop your UC therapy, unless your gastroenterologist says it's ok to do so.
Medication Options: Crohn's & Colitis Foundation. (7/2020). Medication Options for Ulcerative Colitis. crohnscolitisfoundation.org/what-is-ulcerative-colitis/medication
IBD Med Side Effects: Crohn’s & Colitis Foundation. (10/2018). Understanding IBD medications and side effects. crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/aminosalicylates.pdf
Biologics: Crohn’s & Colitis Foundation. (10/2018). Fact Sheet: Biologics. crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/biologic-therapy.pdf