Advancements in Treatment Options for Ulcerative Colitis and Crohn’s Disease

Ulcerative colitis (UC) and Crohn’s disease (CD) fall under the umbrella of inflammatory bowel disease (IBD), characterized by chronic inflammation of the gastrointestinal tract. Ulcerative colitis involves inflammation and ulcers along the lining of the large intestine. Crohn’s disease is characterized by inflammation of the lining as well as deeper layers of the small intestine. These autoimmune conditions, affecting over 3 million adults in the U.S., manifest as diarrhea, rectal bleeding, abdominal pain, fatigue, reduced appetite and unintended weight loss. While their exact cause is unknown, genetic, environmental and lifestyle factors play a role.

Ulcerative colitis is slightly more common than Crohn’s disease in most age groups, except in children, among whom the trend is reversed. Researchers have determined that people who have a first degree relative such as a parent or sibling with the disease are more likely to suffer from IBD. It is also more common in non-Hispanic Caucasians but can affect people of any racial or ethnic group. On average, most patients are diagnosed before the age of 35, but the disease can occur at any age. Over the last decade, the number of people diagnosed with UC and CD has increased. As many as 56,000 new cases are diagnosed each year.

Medications are available that can control disease symptoms. While they do not cure the disease, many patients can go for long periods of time without symptoms. Treatment choice depends on many factors with various medications categorized into aminosalicylates, corticosteroids, immunomodulators and biologics.

Recent biologic advancements include the introductions of adalimumab biosimilars; Zymfentra®, the first subcutaneous biobetter for infliximab for UC and CD; and Tyruko®, the first biosimilar for Tysabri^®. Integrin blockers like Entyvio^® and Tysabri^® prevent inflammation-triggering white blood cells, while interleukin inhibitors such as Stelara^® and Omvoh^® target proteins associated with GI inflammation.

JAK inhibitors like Xeljanz^® and Rinvoq^® offer an oral options, but safety issues are present with this class. S1P modulators, like Zeposia^® and Velsipity^®, reduce inflammation by binding immune cell receptors in UC.

Overall, treatment options for UC and CD have expanded significantly providing additional therapy options after aminosalicylates, corticosteroids and immunomodulators. The treatment landscape is evolving, requiring further research to optimize therapy positioning amidst the growing array of available therapies.

For more information on treatment updates for UC and CD, click here to read this issue’s clinical bulletin.