ANNOUNCER: Ulcerative Colitis is a chronic disease. Although there is no cure, there are effective treatment options.
STEPHEN HANAUER, MD: Even though we don't know what causes ulcerative colitis, we are very familiar with treatments that are usually successful in gaining control of the inflammation and actually allowing the colon to heal completely. We call that a remission, and that's our first goal, to heal the colon. And when the colon is healed, it does its job, and patients again feel normal. But we also know that if we stop treatment that the inflammation will come back. So our second goal of treatment is to maintain that remission and to prevent the symptoms from coming back.
ANNOUNCER: Drug therapies are often chosen based on the severity and extent of disease.
LAWRENCE BRANDT, MD: 5-aminosalicylates are probably universally agreed-upon as the first line of therapy for a person who has mild to moderate illness. These are medications that are taken by mouth. They have their action in the colon. They could be taken by rectum, either by small enema or by suppository, and then their mode of action will be directed just in the rectum or the most distal part of the colon. But it's a very well tolerated form of therapy with very, very few side effects. Most people will tolerate them very well.
ANNOUNCER: Prescribed 5-aminosalicylates or 5-ASAs may include sulfasalazine, olsalazine, mesalamine and balsalazide.
ANNOUNCER: Corticosteriods are another option available to patients.
DAVID RUBIN, MD: Corticosteroids, like prednisone or methylprednisolone, are therapies that we use when the 5-ASA therapy hasn't worked or when patients are sicker and need something that might work fast. One of the nice things about the steroids is that they work quickly, and patients will have some improvement in their symptoms in a short period of time. But we also know there are a lot of intolerable side effects of steroids, and we hate to use them if we could avoid them. We also know that steroids are not effective for maintenance.
STEPHEN HANAUER, MD: The side effects can include increased appetite, weight gain, difficulty sleeping. I say that steroids make the highs high and the lows low. It can lead to a tendency towards diabetes, and long term can cause a thinning of the bones called osteoporosis, or cataract formation.
ANNOUNCER: If patients have not responded to 5-ASAs or have needed corticosteriods to induce remission, doctors often prescribe an immunomodulator.
LAWRENCE BRANDT, MD: The immunomodulators, such as 6-MP or 6-mercaptopurine and azathioprine, are very important medications that can be used to maintain remission in patients with ulcerative colitis. They are not used to achieve remission quickly, because it takes approximately two to three months for those medications to have their effect. But having gotten a patient well, you could then put the patient on these medications if you anticipated that they were going to have significant and severe disease, and you wanted to maintain their health for a long period of time.
ANNOUNCER: Patients on immunomodulators should be closely monitored. Side effects can include a decrease in white blood cell counts, an increased risk of infection, inflammation of the liver and pancreas, and damage to bone marrow.
STEPHEN HANAUER, MD: Occasionally patients have such severe disease that they're not responding and need to be in the hospital or approaching hospitalization. In that situation, two medications called cyclosporin or tacrolimus have been effective in controlling the inflammation. These are usually only used short term during a hospitalization and for several months thereafter as patients are transitioned towards therapy with Imuran or 6-MP. Both cyclosporin and tacrolimus can have a lot of side effects and require therapeutic monitoring.
ANNOUNCER: Recently, a biological therapy called infliximab, has been approved for the treatment of ulcerative colitis.
STEPHEN HANAUER, MD: The biologic therapies are actually antibodies that have been created to target to a chemical of inflammation. In the case of infliximab, that chemical is called TNF, or tumor necrosis factor. And to get that antibody into the system, it requires an intravenous infusion.
LAWRENCE BRANDT, MD: It has the ability to take a patient who is sick with ulcerative colitis, who has frequent exacerbations and infrequent remissions, bothersome, troubling symptoms most of the time, and put them into remission. Once they're put into remission with this medication, it's used to maintain the remission, and is given in a periodic fashion.
ANNOUNCER: Common side effects of infliximab include fever, joint pain, swelling and infections. The drug also carries the risk of reactivating latent tuberculosis. No matter which medication a patient is taking, it is important to stick to the treatment plan.
STEPHEN HANAUER, MD: We know that patients with ulcerative colitis who continue on their medications once they're in remission are much more likely to stay in remission. If they continue on those medications, 80% of patients will stay well. In contrast, and the opposite, if patients stop their medicine, they have an 80% chance of having a flare-up within the year.
ANNOUNCER: There are instances when a doctor may recommend surgery, which requires removing the entire large intestine or colon.
STEPHEN HANAUER, MD: The vast majority of patients with ulcerative colitis can be treated medically throughout their lifetime. But about 20% will require an operation.
DAVID RUBIN, MD: One of the common misperceptions about this disease is that you need to live in fear of relapse, that you need to live with active symptoms. That is not how we manage ulcerative colitis. People need to talk to their doctor and they need to be on treatments that are effective, and when they're not effective, they either need to see another expert for another opinion, or they need to be thinking about surgery, because we want people to have a quality of life when they have this disease.