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Bürger M, Schmidt C, Teich N, et al. Medical Therapy of Active Ulcerative Colitis. Viszeralmedizin. 2015;31(4):236-45doi: 10.1159/000436959.
Bürger, M., Schmidt, C., Teich, N., & Stallmach, A. (2015). Medical Therapy of Active Ulcerative Colitis. Viszeralmedizin, 31(4), 236-45. https://doi.org/10.1159/000436959
Bürger, Martin, et al. "Medical Therapy of Active Ulcerative Colitis." Viszeralmedizin vol. 31,4 (2015): 236-45. doi: https://doi.org/10.1159/000436959
Bürger M, Schmidt C, Teich N, Stallmach A. Medical Therapy of Active Ulcerative Colitis. Viszeralmedizin. 2015 Aug;31(4):236-45. doi: 10.1159/000436959. Epub 2015 Aug 04. PMID: 26557831; PMCID: PMC4608602.
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Viszeralmedizin. 2015 Aug;31(4):236-45. doi: 10.1159/000436959. Epub 2015 Aug 04.

Medical Therapy of Active Ulcerative Colitis.

Viszeralmedizin

Martin Bürger, Carsten Schmidt, Niels Teich, Andreas Stallmach

Affiliations

  1. Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
  2. Group Practice for Digestive and Metabolic Diseases, Leipzig, Germany.

PMID: 26557831 PMCID: PMC4608602 DOI: 10.1159/000436959

Abstract

BACKGROUND: Medical therapy of mild and moderate ulcerative colitis (UC) of any extent is evidence-based and standardized by national and international guidelines. However, patients with steroid-refractory UC still represent a challenge.

METHODS: A literature search using PubMed (search terms: ulcerative colitis, therapy, new, 1-2008-2015) resulted in 821 publications. For the current article, 88 citations were extracted including 36 randomized controlled studies, 18 reviews, and 8 meta-analyses.

RESULTS: In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. In patients with chronic disease activity, treatment with anti-TNF antibodies has a higher level of evidence than azathioprine therapy and should therefore be preferred. However, there is a subgroup of UC patients who may achieve prolonged steroid-free remission on azathioprine monotherapy. The importance of vedolizumab, a newly registered inhibiting antibody against integrin, has not yet been fully clarified since direct comparison studies are lacking, in particular in relation to anti-TNF antibodies.

CONCLUSION: There is a great need for additional innovative therapies, especially in cases of primary non-response or secondary loss of response to anti-TNF antibodies. New small molecules (Janus kinase inhibitors) are promising with an acceptable safety profile and efficacy in UC. Further, strategies that target the intestinal microbiome are currently considered for patients with active or relapsing UC, and may in the future open up new therapeutic options.

Keywords: Anti-TNF; Fecal microbiota transfer; Innovations; Medical therapy; Ulcerative colitis; Vedolizumab

References

  1. Lancet. 2012 Dec 1;380(9857):1909-15 - PubMed
  2. Scand J Gastroenterol. 1996 Mar;31(3):260-6 - PubMed
  3. Br Med J. 1962 Aug 18;2(5302):441-3 - PubMed
  4. Gastroenterology. 2003 Oct;125(4):1025-31 - PubMed
  5. Am J Gastroenterol. 2005 Nov;100(11):2478-85 - PubMed
  6. Lancet. 2010 Feb 20;375(9715):657-63 - PubMed
  7. J Crohns Colitis. 2011 Feb;5(1):28-33 - PubMed
  8. Inflamm Bowel Dis. 2004 Mar;10(2):73-8 - PubMed
  9. Inflamm Bowel Dis. 2014 Aug;20(8):1368-74 - PubMed
  10. Aliment Pharmacol Ther. 2007 Nov 1;26(9):1237-49 - PubMed
  11. World J Gastroenterol. 2015 Feb 14;21(6):1880-6 - PubMed
  12. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD000543 - PubMed
  13. Inflamm Bowel Dis. 2010 Nov;16(11):1947-56 - PubMed
  14. Cochrane Database Syst Rev. 2012 Nov 14;11:CD004118 - PubMed
  15. J Crohns Colitis. 2013 Dec;7(12):e609-14 - PubMed
  16. Aliment Pharmacol Ther. 2014 Mar;39(6):579-94 - PubMed
  17. Inflamm Bowel Dis. 2014 Jan;20(1):36-46 - PubMed
  18. J Crohns Colitis. 2011 Apr;5(2):91-4 - PubMed
  19. World J Gastroenterol. 2014 Nov 14;20(42):15657-63 - PubMed
  20. N Engl J Med. 2013 Aug 22;369(8):699-710 - PubMed
  21. Aliment Pharmacol Ther. 2007 Jul 1;26(1):21-9 - PubMed
  22. J Crohns Colitis. 2010 Feb;4(1):102-5 - PubMed
  23. J Crohns Colitis. 2014 Nov;8(11):1427-37 - PubMed
  24. Gut. 1986 Oct;27(10):1210-2 - PubMed
  25. Gastroenterology. 2007 Jan;132(1):66-75; quiz 432-3 - PubMed
  26. Aliment Pharmacol Ther. 2007 Jul 15;26(2):205-15 - PubMed
  27. Am J Gastroenterol. 2008 Dec;103(12):3106-14 - PubMed
  28. BMJ Open. 2012 Apr 05;2(2):e000823 - PubMed
  29. Aliment Pharmacol Ther. 2007 Aug 1;26(3):411-9 - PubMed
  30. Eur J Gastroenterol Hepatol. 2014 Nov;26(11):1240-6 - PubMed
  31. Eur J Gastroenterol Hepatol. 1998 Oct;10(10):831-5 - PubMed
  32. Gastroenterology. 2015 Jul;149(1):102-109.e6 - PubMed
  33. Aliment Pharmacol Ther. 2007 Sep 1;26(5):747-56 - PubMed
  34. Am J Gastroenterol. 2013 Jan;108(1):90-8 - PubMed
  35. Clin Gastroenterol Hepatol. 2007 Jan;5(1):103-10 - PubMed
  36. Br Med Bull. 2006 Jul 17;75-76:131-44 - PubMed
  37. N Engl J Med. 2005 Dec 8;353(23):2462-76 - PubMed
  38. Am J Gastroenterol. 2003 Nov;98(11):2363-71 - PubMed
  39. N Engl J Med. 2012 Aug 16;367(7):616-24 - PubMed
  40. Gut. 2014 Mar;63(3):442-50 - PubMed
  41. Gut. 2013 Apr;62(4):531-9 - PubMed
  42. Aliment Pharmacol Ther. 2015 Mar;41(5):409-18 - PubMed
  43. Br Med J. 1955 Oct 29;2(4947):1041-8 - PubMed
  44. Aliment Pharmacol Ther. 1998 Oct;12(10):973-8 - PubMed
  45. Am J Gastroenterol. 2013 Oct;108(10):1620-30 - PubMed
  46. Curr Opin Gastroenterol. 2014 Jan;30(1):84-96 - PubMed
  47. Am J Gastroenterol. 1997 Oct;92(10):1867-71 - PubMed
  48. Aliment Pharmacol Ther. 2004 May 15;19(10):1079-87 - PubMed
  49. Inflamm Bowel Dis. 2007 Oct;13(10 ):1244-9 - PubMed
  50. Dig Dis. 2013;31(1):91-4 - PubMed
  51. World J Gastroenterol. 2014 Feb 7;20(5):1192-210 - PubMed
  52. Gut. 1985 Dec;26(12):1380-4 - PubMed
  53. Eur J Gastroenterol Hepatol. 1996 Jun;8(6):549-53 - PubMed
  54. Gut. 2009 Feb;58(2):233-40 - PubMed
  55. Inflamm Bowel Dis. 2006 Oct;12(10):979-94 - PubMed
  56. Cochrane Database Syst Rev. 2012 Oct 17;10:CD000543 - PubMed
  57. Aliment Pharmacol Ther. 2009 Feb 1;29(3):247-57 - PubMed
  58. Am J Gastroenterol. 2012 Feb;107(2):167-76; author reply 177 - PubMed
  59. Lancet. 2014 Jul 26;384(9940):309-18 - PubMed
  60. N Engl J Med. 1994 Jun 30;330(26):1841-5 - PubMed
  61. Gut. 2011 Aug;60(8):1068-75 - PubMed
  62. Gut. 2015 Feb;64(2):243-9 - PubMed
  63. Gut. 1997 Jun;40(6):775-81 - PubMed
  64. Inflamm Bowel Dis. 2011 Dec;17(12):2497-502 - PubMed
  65. J Crohns Colitis. 2012 Dec;6(10):991-1030 - PubMed
  66. Gut. 2000 Sep;47(3):410-4 - PubMed
  67. BMC Gastroenterol. 2007 Mar 27;7:13 - PubMed
  68. J Neuroimmunol. 2013 Nov 15;264(1-2):123-6 - PubMed
  69. Gut. 2013 Aug;62(8):1122-30 - PubMed
  70. Eur J Gastroenterol Hepatol. 2010 Aug;22(8):912-6 - PubMed
  71. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD007216 - PubMed
  72. Expert Rev Gastroenterol Hepatol. 2015 May;9(5):693-700 - PubMed
  73. Inflamm Bowel Dis. 2014 Aug;20(8):1375-81 - PubMed
  74. J Crohns Colitis. 2010 Oct;4(4):398-404 - PubMed
  75. Clin Gastroenterol Hepatol. 2006 Feb;4(2):196-202 - PubMed
  76. Gastroenterology. 2005 Jun;128(7):1805-11 - PubMed
  77. Gut. 2015 Jun;64(6):894-900 - PubMed
  78. Scand J Gastroenterol. 2009;44(11):1310-4 - PubMed
  79. Am J Gastroenterol. 1994 Jan;89(1):43-6 - PubMed
  80. Scand J Gastroenterol. 2009;44(4):431-40 - PubMed
  81. Aliment Pharmacol Ther. 2013 Jan;37(1):129-36 - PubMed
  82. Z Gastroenterol. 2012 Apr;50(4):396-406 - PubMed
  83. Dig Dis. 2010;28(3):536-42 - PubMed
  84. Pharmacol Res. 2013 Oct;76:1-8 - PubMed
  85. Lancet. 1974 Jun 1;1(7866):1067-70 - PubMed
  86. Am J Gastroenterol. 2011 Apr;106(4):601-16 - PubMed
  87. Gastroenterology. 2015 Jul;149(1):110-118.e4 - PubMed

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