Ulcerative Colitis Research Updates

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD). It occurs when an immune system response causes inflammation of the inner lining of the large intestine. It is unclear what motivates this response.

Medicines to reduce inflammation are the main treatment. There is a growing list of drugs approved for the treatment of UC. And biosimilars expand the options even further.

Research into the causes and contributing factors of UC is ongoing. Scientists are looking at topics such as the microbiome, genetics and environmental factors.

Finding the cause of UC can be the key to more effective treatments. It could also lead to strategies for preventing UC in the first place.

In this article, we will discuss new treatments and studies on UC and where the research is going.

A study published in 2020 assessed the role of gut microbes in gut inflammation.

When medications don’t manage UC symptoms effectively, surgery may be the next step. This may involve removing the colon and creating an ileo-anal pouch to function in place of the rectum.

On half of people who have this procedure for UC continue to have pocket inflammation (pouchitis). However, this is rarely the case for people who have surgery for other reasons.

Researchers found that those who developed pouchitis had low levels of secondary bile acids in their digestive tract. They also had low levels of Ruminococcaceae bacteria. If confirmed, this could lead to the development of supplements to supply missing gut microbes or restore the bacteria that produce them.

A 2021 study found bacterial changes in the gut before developing UC. With further research, doctors may be able to identify those at risk for UC. This could pave the way for precision drugs designed to prevent UC.

Other avenues of research into the causes of UC include:

  • environmental factors
  • lifestyle factors such as smoking, diet, and exercise
  • genetic

Ongoing research into treatment options includes:

  • fecal microbiota transplant (FMT)
  • stem cell therapy
  • probiotics

There are currently dozens of medications available to treat UC. Your doctor may prescribe one or more of the following:

  • Aminosalicylates (5-ASA). These drugs are taken orally or rectally to reduce inflammation in the lining of the gastrointestinal tract. They are effective in treating mild to moderate UC flare-ups.
  • Corticosteroids. For moderate to severe UC, your doctor may prescribe corticosteroids. They suppress the immune system response. Corticosteroids should not be used long term due to the risk of side effects.
  • Immunosuppressants. This class of drugs suppresses the immune system to help reduce inflammation. Your doctor may prescribe immunosuppressants if aminosalicylates and corticosteroids have not been effective.
  • Organic Products. Biologic drugs are used to treat people with moderate to severe UC. They target specific proteins in the body that cause inflammation.
  • Biosimilars. A biosimilar drug is almost identical to an existing biologic drug approved by the Food and Drug Administration (FDA).
  • Janus kinase (JAK) inhibitors. JAK inhibitors block an enzyme involved in triggering inflammation.

Recent Approvals

Several UC drugs have been approved in the past two years.

Drugs approved in 2021 include:

  • Ozanimod (Zeposia). This medication is for adults with moderate to severe UC. It is the first oral sphingosine 1-phosphate (S1P) receptor modulator approved for UC. Results of stage 2 and phase 3 clinical trials suggest it is an effective first-line and maintenance treatment. It was also generally well tolerated.
  • Adalimumab (Humira). Adalimumab is a type of biologic medicine called a tumor necrosis factor (TNF) blocker. It was approved for UC in 2012. In 2021, it became the first approved subcutaneous biologic treatment for people aged 5 and older with moderate to severe UC. Phase 3 clinical trials have demonstrated clinically significant remission and response rates in children.
  • Adalimumab-adbm (Cyltezo). This is a biosimilar approved for adults with moderate to severe UC.

Drugs approved in 2020 include:

  • Adalimumab-fkjp (Hulio). It is an approved biosimilar for adults with moderate to severe UC who have had an inadequate response to other treatment.
  • Infliximab-axxq (Avsola). A biosimilar, infliximab-axxq is an approved treatment option for adults with moderate to severe UC who have had an inadequate response to other therapy.

Clinical trials study the safety and effectiveness of new treatments. Signing up for a trial can give you access to treatments not yet available elsewhere. Your doctor can help you locate clinical trials and assess your eligibility.

These are just a few of the UC clinical trials currently underway:

  • The role of secondary bile acids in intestinal inflammation. The aim of this trial is to determine if ursodeoxycholic acid can reduce inflammatory markers and improve quality of life in people with pouchitis.
  • A cohort study comparing IFX to CS for moderate to severe UC (INSURE). This study will compare the efficacy and safety of biologic infliximab to corticosteroids when used as first-line therapy.
  • Adherence to a single 1600 mg tablet of 5-ASA for the treatment of ulcerative colitis (EASI). The EASI trial will examine whether a simpler treatment regimen for 5-ASA improves adherence while preserving remission rates compared to conventional treatment.
  • Adipose mesenchymal stem cells (AMSC) for the treatment of ulcerative colitis (AMSC_UC). This trial will assess the safety and efficacy of intracolonic injections of SCMA in people with moderate UC. Recent research shows that mesenchymal stem cells may have anti-inflammatory properties.

You can learn more about these and other clinical trials at clinicaltrials.gov.

In the search for a cause of UC, studies have identified at least 260 genetic variants that may affect the risk of IBD. As with other diseases, knowledge of genetic risk factors can lead to prevention strategies and precision medication for UC.

Health technology can also advance the treatment of UC. Digital applications and biosensors are hot topics in research.

In a paper published in 2020, researchers described a wearable, noninvasive device that monitors sweat for inflammatory biomarkers. Researchers hypothesize that tracking inflammation may help identify IBD flare-ups. It could also let doctors know if the current treatment is working.

According to the Crohn’s & Colitis Foundation, IBD research gaps that should be prioritized include:

  • non-invasive detection and monitoring of active inflammation and assessment of treatment response
  • mucosal targeted drug delivery systems
  • prevention of postoperative septic complications and treatment of fistulizing complications

The outlook for people with UC is better today than ever. This is largely due to new drugs that help control inflammation in the colon. A wider choice of medications means that if your treatment isn’t working, you have other options.

As researchers learn more about the causes of UC, we can expect further advances in treatment. Identifying risk factors can also help doctors prevent the development of UC.

Research is progressing at a rapid pace. So, there are plenty of reasons for hope.

If you have UC, talk to your doctor about the latest findings and how they might affect your treatment.

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