Estimated reading time: 6 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Inflammation in the colon from ulcerative colitis (UC) is a frustrating symptom to deal with. This symptom can significantly impact your quality of life. UC causes inflammation and ulcers in the colon, which leads to issues like abdominal pain, diarrhea, and rectal bleeding. There is no cure for UC, but certain medications can help control the inflammation and put it in remission. So - what medications do you need to be aware of? Here, PatientsLikeMe will look at the options for treating UC, when and why they work most effectively, and what you as a patient should know.
Why Does UC Lead to Inflammation?
UC is a type of inflammatory bowel disease (IBD) where the immune system mistakenly attacks the lining of the colon. This immune system attack leads to chronic inflammation. Over time this causes damage to the colon. If left untreated, inflammation just gets worse, increasing the risk of complications like severe bleeding or colon cancer. The goal of UC treatment is to lower this inflammation, reduce symptoms, and improve quality of life. That is primarily done through medications.
Medications for UC and Colon Inflammation
Medications are usually the first line of treatment for UC. Which medication a doctor will recommend depends on how severe the disease is, your overall health, and how you respond to treatment. Generally, there are a few main categories of medication a doctor will turn to. Here are the 5 you should know about.
Aminosalicylates (5-ASA)
Aminosalicylates contain 5-aminosalicylic acid. This works directly in the colon to reduce inflammation. They act on the lining of the gastrointestinal tract, calming inflammation and helping it heal. These drugs are often the first choice for patients with mild to moderate UC and can help prevent relapses. However, 5-ASA drugs are not recommended for severe UC according to the American College of Gastroenterology (ACG) guidelines. They usually come in pill form and are taken orally but can be rectal enemas or suppositories depending on where the inflammation is in the colon. Some common examples of 5-ASA drugs are:
- Sulfasalazine
- Mesalamine
- Olsalazine
- Balsalazide
5-ASAs can occasionally cause side effects like headaches or kidney issues. You may need regular blood tests to monitor kidney function during treatment.
Corticosteroids
Corticosteroids are powerful anti-inflammatory drugs used for moderate to severe UC or for flare-ups that don’t respond to other treatments. These medications broadly suppress the immune system, which reduces inflammation quickly. They can come in pill form, or as injections or rectal therapies. Common examples are:
- Prednisone
- Prednisolone
- Budesonide
Corticosteroids are not meant for long-term use because of their potential side effects. These can be things like weight gain, osteoporosis, high blood pressure, and mood changes. They are typically used short-term to bring UC under control. After that, a different medication is used to keep the disease in remission.
Immunomodulators
Immunomodulators also help control UC by suppressing the immune system. These are usually prescribed when aminosalicylates or corticosteroids fail to control symptoms effectively. They come in pill form or are given by injection. Examples of immunomodulators are:
- Azathioprine
- 6-mercaptopurine (6-MP)
- Cyclosporine
Immunomodulators take longer to work than corticosteroids, often up to several weeks or months. They can, however, reduce the need to take corticosteroids and limit those side effects. Patients using these drugs need regular blood tests to monitor for liver issues or low white blood cell counts.
Targeted Synthetic Small Molecules
These are newer oral medications that specifically target parts of the immune system involved in inflammation. By blocking certain immune pathways, these drugs help reduce inflammation in the colon. Some examples are:
- Tofacitinib
- Ozanimod
- Upadacitinib
These medications are designed for adults with moderate to severe UC who haven’t responded to other treatments. Side effects may include increased risk of infections.
Biologics and Biosimilars
Biologics are protein-based drugs made from living cells that target specific parts of the immune system to reduce inflammation. They block proteins, such as tumor necrosis factor (TNF) or interleukins, that contribute to inflammation. Some examples of biologics are:
- Adalimumab
- Infliximab
- Vedolizumab
- Ustekinumab
Biosimilars, on the other hand, are nearly identical copies of biologics that offer the same benefits and safety. Biologics are typically used for moderate to severe UC and are given as injections or infusions. Patients may need regular monitoring for infections or allergic reactions.
Considerations
The first thing a doctor will consider is the severity of the disease. Mild UC may respond to aminosalicylates, while moderate-to-severe cases might require corticosteroids, immunomodulators, or biologics. Next is the location of the inflammation. Rectal therapies like enemas or suppositories work well for inflammation near the rectum, while oral medications are better for widespread inflammation. Each medication has side effects, so it’s important to weigh the benefits against the risks. Finally, you should consider your long-term goals for treatment. Some medications are for short-term flare-ups, while others help maintain remission.
Medications are an essential part of managing UC, helping reduce inflammation, alleviate symptoms, and improve quality of life. Working closely with your doctor to find the right medication plan is critical. While no medication can cure UC, the right treatment can help you live a healthier, more comfortable life. If you’re navigating UC treatment, understanding your options is the first step toward effective management. Remember, what works best will depend on your unique health needs and lifestyle. Always discuss your concerns and goals with your healthcare team.
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