Treatments – Understanding Ulcerative Colitis

TREATMENTS and MEDICATIONS

TREATMENT

and

MEDICATION

Although there is not currently a cure for ulcerative colitis, numerous types of treatments and medications exist to eliminate symptoms and retain a state of remission for patients. Medications like immunosuppressants and biologics are commonly used in patients that experience moderate-to-severe ulcerative colitis and used as a preventative measure for those who do not currently experience symptoms. Other possible treatments for ulcerative colitis are non-medicinal, including exercise, therapy, and diet. All patients are different and may require unique treatment; it is crucial to understand the benefits, functions, and risks of each available treatment.

My Treatment Experience

Through my journey with ulcerative colitis, I have experimented with all of the treatment types discussed on this platform: immunosuppressants (like prednisone and azathioprine), non-medicinal treatments (specifically gluten removal), and several biologics including Humira, Stelara, and Inflectra (a biosimilar to Remicade). The most extreme treatment I have received for my ulcerative colitis symptoms is surgery (a total colectomy).

Every treatment type that I have tried was for a different reason, in a different stage with the disease, whether it was to control inflammation, maintain a state of remission, or to physically remove the source of inflammation altogether.

This picture is of my calendar appointments made for my Humira injections. I began with a loading dose and from then on, did the injections from home. Humira was the first biologic I ever used; in my case, it was a last ditch effort to gain control of the inflammation in my colon. Unfortunately, it did not work quickly enough and shortly after, I received surgery.

Immunosuppressants

Immunosuppressants are a type of medication that act by decreasing overactive immune responses in the body. In contrast to biologics, immunosuppressants typically come in the form of oral tablets and are used to treat mild-to-moderate flares or remain stable in remission. The effect of immunosuppressants make take longer to kick in but are ultimately effective in treating ulcerative colitis, especially if other medications have not eliminated symptoms (National Health Service UK). As implied in the name, these kinds of medications suppress the immune system, increasing infections and lower red blood cell counts. Pregnant women are specifically at risk when taking immunosuppressants, as they can cause fertility issues and other adverse side effects (Hussian, Khan). Common immunosuppressants used to treat ulcerative colitis include steroids like prednisone as well as anti-metabolites like azathioprine.

Immuno-suppressants

Immunosuppressants are a type of medication that act by decreasing overactive immune responses in the body. In contrast to biologics, immunosuppressants typically come in the form of oral tablets and are used to treat mild-to-moderate flares or remain stable in remission. The effect of immunosuppressants make take longer to kick in but are ultimately effective in treating ulcerative colitis, especially if other medications have not eliminated symptoms (National Health Service UK). As implied in the name, these kinds of medications suppress the immune system, increasing infections and lower red blood cell counts. Pregnant women are specifically at risk when taking immunosuppressants, as they can cause fertility issues and other adverse side effects (Hussian, Khan). Common immunosuppressants used to treat ulcerative colitis include steroids like prednisone as well as anti-metabolites like azathioprine.

Non-Medicinal Treatments

Diet

Diet is a common way for ulcerative colitis patients to holistically cope with their disease and symptoms. “Reports indicate up to 68% of patients restrict their diet in an attempt to control symptoms and avoid exacerbation of the disease” (Duff et al). Each diet is different and provides unique benefits, if followed strictly.

Mediterranean Diet

The Mediteranean diet is full of plant foods like fruits, vegetables, legumes, nuts, and seeds and utilizes olive oil to add fat. Additionally, this diet allows more for consumption of seafood eggs, poultry, and dairy, but less for red meat and alcohol (Duff et al). Over time (if followed), the Mediterranean diet does show evidence of decreasing gut inflammation and improving overall health.

Plant-Based Diets

A plant-based diet excludes animal products and meat. There are many perks of this eating style. In fact, “consumption of a vegetarian diet is associated with a number of health benefits such as a significantly lower risk for ischemic heart disease mortality (29%), overall cancer incidence (18%), and lower risk of developing Type 2 Diabetes” (Duff et al). Many foods that are believed to increase the severity of ulcerative colitis, such as fast food, sweets, and carbonated beverages, are discouraged as part of the plant-based diet (Duff et al).

Exclusion Diets

Many exclusion diets are becoming relevant to IBD, such as the specific carbohydrate diet, IBD anti-inflammatory diet (IBD-AID), and gluten-free diet. The specific carbohydrate diet “restricts complex carbohydrates and eliminates refined sugar from the diet” as those could add to intestinal inflammation (Duff et al). The IBD anti-inflammatory diet modifies carbohydrates and encourages the intake of prebiotics and probiotics. Many patients who have tried this diet have seen reduced symptoms due to the fact that the IBD-AID encourages healthy eating habits (Duff et al). The gluten-free diet excludes foods containing gluten from consumption which can greatly aid digestion and promote a healthier lifestyle.

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Stress Management

There are numerous ways that an ulcerative colitis patients can improve their physical health by simply managing stress in a positive and productive manner. Whether it be support groups, one-on-one, or even practicing mindfulness, therapy can help those struggling with invisible illness feel less isolated and more connected to themselves.

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Different types of stress management include cognitive behavioral therapy, mindfulness-based therapy, and multi-component behavioral treatment. Cognitive behavioral therapy is a “collaborative problem-solving approach between the client and therapist, which aims to collaboratively identify, challenge, and modify maladaptive thoughts and behaviors” (Duff el al). Mindfulness-based therapy provides a welcoming space where patients can focus on the present. Multi-component behavioral treatment is a “psychological intervention that combines muscle relaxation techniques, thermal biofeedback, training in coping, and education in IBD” (Duff et al). This treatments gives patients the power of knowledge and stress reduction.

Physical Activity and Exercise

Incorporating consistent physical activity and exercise into daily life is beneficial to all people, but especially those with ulcerative colitis or other autoimmune diseases. Examples of these types of beneficial exercise include structured exercise, cardiovascular training, and resistance training (Duff et al). Not only does exercise strengthen the body, but it strengthens the mind as well.

The goal of structured exercise is to reduce fatigue, disease symptoms, and increase the general well-being of UC patients. Cardiovascular training can potentially improve UC symptoms, regulate stress, and improve social and physical fitness (Duff et al). Resistance training creates strength and stamina as well as improvement of bone health. This is extremely important, given that some medicinal treatments for ulcerative colitis, like steroids, negatively impact bone density. Overall, exercise is crucial because “lower levels of physical activity are associated with fatigue, systemic inflammation, and reduced cardiovascular fitness” (Duff et al). Those who exercise regularly experience a greater quality of life with ulcerative colitis.

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Biologics

Biologics are medications that are derived from living organisms, such as proteins, genetic material, and nucleic acids (Cleveland Clinic). The National Institute for Health and Care Excellence recommends biologics for patients with moderate-to-severe ulcerative who do not respond to conventional medical treatments (Humza et al). Although some patients and providers view biologic treatments as a “last resort,” they may actually be an effective first line of defense for patients with specific cases of ulcerative colitis. However, some studies have shown that using biologics quickly after diagnosis can increase the odds of requiring a colectomy in ulcerative colitis (Law et al). The currently approved biologics for UC are listed and explained below.

Infliximab (Remicade)

Remicade has been proven to increase mucosal healing, “corticosteroid-free clinical remission, and endoscopic remission, “…suggesting that it as the preferential agent for biologic naïve UC patients” (Humza et al). It is crucial that this medication increases mucosal healing, as mucosal healing is a strong predictor of a lessened risk of cancer among ulcerative colitis patients. However, in many UC patients, the effects of Remicade may wear off over time, “…reducing from 69% (week 8) to 45% (week 54)” (Humza et al). This loss of response can be combatted in some cases with an increase in dosage to maintain a state of remission.

Adalimumab (Humira)

Humira treats a variety of autoimmune diseases, like ulcerative colitis, Crohn’s disease, arthritis, and psoriasis. For ulcerative colitis patients specifically who experience moderate to severe symptoms, Humira is generally considered a safe and effective treatment. Patients who take Humira can experience short-term and long-term relief. Humira functions by slowing down overactive immune systems and is administered by injection (Cleveland Clinic). Due to the fact that Humira can decrease the strength of the immune system, infections are a common side effect, as well as possible allergic reactions, bruising, bleeding, or unusual fatigue.

Golimumab (Simponi)

Simponi is typically a safe treatment for those with moderate to severe ulcerative colitis and is “…a fully human monoclonal antibody that binds to both membrane-bound and soluble anti-TNF” (Cunningham et al). Additionally, Simponi has been found to induce remission, mucosal healing, and improve quality of life after about 6 weeks on the medication (Humza et al). Similarly to Humira, Simponi can be self-administered by injection, allowing patients more flexibility and independence. The Simponi doses are more infrequent compared to some other biologics, increasing convenience for patients. A significant problem with Simponi is the decrease in effectiveness over time, which could be due to the “…formation of antidrug antibodies, as the drugs evoke an immune response”; the loss of response may be improved with dose escalation, but it trickier with Simponi to increase dosage because it is not within license (Cunningham et al).

Vedolizumab (Entyvio)

Entyvio treats both forms of inflammatory bowel diseases (ulcerative colitis and Crohn’s disease). Administered by injection or infusion, Entyvio functions by decreasing digestive tract inflammation. Entyvio works by blocking proteins on the surface of particularly inflamed white blood cells in the gut (European Medicines Agency). A critical component of Entyvio is cost; it is an incredibly expensive treatment because it is used to eliminate symptoms for the long-haul. However, Entyvio is highly cost effective, as it significantly increases the quality of life in patients compared to other biologics (Humza et al). For those who can afford it or have stable insurance, Entyvio may be a suitable fit.

Ustekinumab (Stelara)

Stelara has the capability to treat numerous inflammatory conditions, such as psoriasis, arthritis, and inflammatory bowel disease and is administered through subcutaneous injection or infusion. Many different proteins that occur naturally in the body are responsible for inflammation, specifically “interleukin 12 (IL-12) and interleukin 23 (IL-23) have been implicated as important contributors to the chronic inflammation that is a main feature of ulcerative colitis” (Stelara Info). Stelara reduces inflammation in the gastrointestinal tract by targeting those 2 particular proteins, which distinguishes it from other biologics. Stelara can negatively impact the immune system, causing potential infections, allergic reactions, stomach or joint pain, fever, and fatigue.

Understanding Ulcerative Colitis

Copyright 2025 Allyson Bartels Thesis

Understanding Ulcerative Colitis

Copyright 2025 Allyson Bartels Thesis