Overview of maintenance therapy for ulcerative colitis in adults

Ulcerative colitis is a relapsing and remitting condition; most patients need ongoing therapy to maintain remission. Options for drug therapy to maintain remission include 5-aminosalicylates, thiopurines, and biological therapies (eg adalimumab, golimumab, infliximab, tofacitinib, ustekinumab, vedolizumab).

Biological therapies are effective in maintaining remission if there was response to induction therapy with these drugs; refer to a gastroenterologist. Long-term biological therapy may be required to maintain remission in some patients.

Corticosteroids should not be used as maintenance therapy to prevent relapse of ulcerative colitis because they are no more effective than placebo and are associated with serious long-term adverse effects.

Surgery (proctocolectomy with either ileal pouch–anal anastomosis or end-ileostomy) may be considered for chronically active disease that is refractory to drug therapy. Up to 50% of patients who have had an ileal pouch–anal anastomosis develop pouchitis (inflammation of the ileal pouch); antibiotic therapy with metronidazole or ciprofloxacin is usually effective for pouchitis, but repeated courses may be required.

Therapy for ulcerative colitis is usually lifelong. De-escalation of therapy should only be considered in patients with stable disease and evidence of mucosal healing on endoscopy—consult the patient’s gastroenterologist before attempting de-escalation.

Patients with longstanding ulcerative colitis (ie lasting 8 years or more) have an increased risk of colorectal cancer—periodic colonoscopies are required for monitoring at intervals determined by individualised risk stratificationMagro, 2017.