update on the management of ulcerative colitis

the present treatment goals for inflammatory bowel diseases (ibd) especially ulcerative colitis (uc) include rapid induction of clinical remission, steroid-free maintenance of clinical remission, mucosal healing and improvement of quality of life in uc patients. immunomodulators have been reserved for steroid- dependent or steroid- refractory uc patients. among these agents, azathioprine/6-mercaptopurine should be used for maintenance of remission in quiescent uc. calcineurin inhibitors can be prescribed as a short-term rescue therapy in steroid- refractory uc patients, but the long term efficacy of these agents remains unclear. according to retrospective studies, methotraxate is not recommended for inducing and maintaining remission in uc. novel biological therapies targeting different specific immunological pathways continue to be developed and introduced for a variety of clinical scenarios in ibd. infliximab is currently used for induction and maintenance therapy in patients who have moderately to severely active uc with an inadequate response to conventional agents such as aminosalicylates, corticosteroids, or immunomodulators. other anti-tnf agents and biologic therapies are undergoing evaluation in clinical trials for their efficacy in ibd. most patients who start biologics should continue treatment for the foreseeable future and potential consequences of discontinuation should be discussed with individual patients. currently, data do not exist to administer biologics as first-line therapy in uc. emerging data suggest that biologics may have the potential to prevent complications and limit disease progression. if such benefits are proven, biologics may be used in the future to modulate subclinical inflammation and to prevent the development of clinical disease.