Current position and future trends of therapy in ulcerative colitis

Abstract

In the last 20 years there has been significant progress in both the pharmacotherapy and surgical therapy of inflammatory bowel diseases, including Crohn's disease and ulcerative colitis. In patients with ulcerative colitis, aminosalicylates represent the fundamental part of the treatment. Aminosalicylates can be used orally, locally or in combination. At least 30 to 40% of patients with ulcerative colitis require therapy intensification, which consists of glucocorticoids, immunosuppressants and biological therapy. The major indication for biological therapy is a cortico-dependent or cortico-refractory course of the disease, or patients who have failed to respond to immunosuppressive therapy. Infliximab was introduced to the clinical practice in 2006 for the treatment of ulcerative colitis patients and there is significant and long-term experience with this drug. A short-term positive response to infliximab was detected in 80-90% treated patients. Beside the innovation and introduction of new medicines, a novel approach for the future is based on newly emerging therapeutic concepts. The first is based on selection of patients with ulcerative colitis who are at risk, and initiating early aggressive therapy before structural damage in the large bowel occurs. The second is focused on close monitoring of inflammatory activity beyond the symptoms (treat to target concept).