Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Aug 7;7:F1000 Faculty Rev-1207.
doi: 10.12688/f1000research.15159.1. eCollection 2018.

Recent Advances and Emerging Therapies in the Non-Surgical Management of Ulcerative Colitis

Affiliations
Free PMC article
Review

Recent Advances and Emerging Therapies in the Non-Surgical Management of Ulcerative Colitis

Jan Wehkamp et al. F1000Res. .
Free PMC article

Abstract

The so-called "biologicals" (monoclonal antibodies to various inflammatory targets like tumor necrosis factor or integrins) have revolutionized the treatment of inflammatory bowel diseases. In ulcerative colitis, they have an established role in inducing remission in steroid-refractory disease and, thereafter, maintaining remission with or without azathioprine. Nevertheless, their limitations are also obvious: lack of primary response or loss of response during maintenance as well as various, in part severe, side effects. The latter are less frequent in anti-integrin treatment, but efficacy, especially during induction, is delayed. New antibodies as well as small molecules have also demonstrated clinical efficacy and are soon to be licensed for ulcerative colitis. None of these novel drugs seems to be much more effective overall than the competition, but they provide new options in otherwise refractory patients. This increasing complexity requires new algorithms, but it is still premature to outline each drug's role in future treatment paradigms.

Keywords: biologicals; small molecules; therapy; ulcerative colitis.

Conflict of interest statement

Competing interests: Jan Wehkamp has received lecture fees from Falk, AbbVie, Takeda, MSD, Roche, Ferring, and Shire and consulting fees from MSD, Takeda, Novartis, Shire, AbbVie, and Ardeypharm; he is a board member of Defensin Therapeutics and has received honoraria for clinical trials from Amgen, Novartis, Falk, and AbbVie. Eduard F. Stange has received lecture fees from AbbVie, Dr. Falk Pharma, Ferring, and Takeda and advisory board fees from Merck, Takeda, and Jansen. He has received honoraria for clinical studies from AbbVie, Falk, Takeda, Celgene, Gilead, Amgen, Boehringer, Salix, and Pfizer.No competing interests were disclosed.Competing interests: Consultant for Janssen, Gilead, Seres Therapeutics, Boehringer Ingelheim, Theravance. No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Numbers needed to treat (traditional and real life).
A. The traditional end point of “number needed to treat” ( tNNT, number of patients required to obtain one additional remission by the treatment compared to placebo: 100% / difference between treatment and placebo in %). B. The “real life” NNT ( rlNNT, number of patients to achieve one remission including the placebo effect: 100% / total % of patients in remission following treatment). Ada, adalimumab Ultra 1 and Ultra 2 trials; Inflix, infliximab ACT1 and ACT2 trials; Madcam, MAdCAM antibody PF-00547659; Tofa, tofacitinib Octave 1 and 2 trials.

Similar articles

See all similar articles

Cited by 2 articles

References

    1. Hansson GC: Role of mucus layers in gut infection and inflammation. Curr Opin Microbiol. 2012;15(1):57–62. 10.1016/j.mib.2011.11.002 - DOI - PMC - PubMed
    1. Ungaro R, Mehandru S, Allen PB, et al. : Ulcerative colitis. Lancet. 2017;389(10080):1756–70. 10.1016/S0140-6736(16)32126-2 - DOI - PMC - PubMed
    1. Safroneeva E, Vavricka S, Fournier N, et al. : Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients. Aliment Pharmacol Ther. 2015;42(5):540–8. 10.1111/apt.13307 - DOI - PubMed
    1. Eriksson C, Cao Y, Rundquist S, et al. : Changes in medical management and colectomy rates: a population-based cohort study on the epidemiology and natural history of ulcerative colitis in Örebro, Sweden, 1963-2010. Aliment Pharmacol Ther. 2017;46(8):748–57. 10.1111/apt.14268 - DOI - PubMed
    2. F1000 Recommendation

    1. Molodecky NA, Soon IS, Rabi DM, et al. : Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54.e42; quiz e30. 10.1053/j.gastro.2011.10.001 - DOI - PubMed
    2. F1000 Recommendation

MeSH terms

Grant support

The author(s) declared that no grants were involved in supporting this work.
Feedback