When to Try a New Ulcerative Colitis Treatment?

At some point, your ulcerative colitis treatment may stop working as well as it once did. However, you can work with your doctor to explore new medication options.

Living with ulcerative colitis means you may enjoy long periods of remission where you don’t experience any symptoms, but then you can suddenly experience flare-ups with abdominal cramping, bloody diarrhea, or the urgent need to defecate.

Finding the right treatment plan can definitely help, but sometimes it’s hard to find the right strategy. It’s also possible that you’ll need to change treatments somewhere along the way. As you navigate the treatment journey, be open with your doctor about your symptoms.

The main goal of treatment for ulcerative colitis is to reduce the inflammation that’s causing symptoms such as pain and diarrhea while helping move your condition toward remission.

Your doctor might start by recommending lifestyle changes, such as adjusting your dietary plan to avoid foods that cause flare-ups and taking medication to help reduce the inflammation in your large intestine.

Medications for ulcerative colitis can include:

• Aminosalicylates: This drug group includes sulfasalazine (Azulfidine) and mesalamine (Delzicol). It’s used to reduce inflammation and lets damaged intestinal tissue heal.
• Corticosteroids: This drug group includes methylprednisolone (Solu-Medrol). It’s used to reduce inflammation and treat flare-ups.
• Immunosuppressants: This drug group includes infliximab (Remicade) and adalimumab (Humira). It targets the activity of your immune system to help reduce your symptoms but can make you more vulnerable to infections.
• Biologic medications: This drug group targets proteins that cause inflammation. It includes medications such as infliximab (Remicade), adalimumab (Humira), and risankizumab-rzaa (Skyrizi).
• Janus kinase (JAK) inhibitors: This drug group includes tofacitinib (Xeljanz) and upadacitinib (RinvoQ). It’s used to prevent certain enzymes in the body from triggering inflammation.

Surgery to remove part or all of the colon and rectum is also a possible option. However, doctors usually recommend it for people who do not respond to prescribed medications or have serious or life threatening complications.

Your medication will depend on how severe your UC symptoms are. You might start with a first-line treatment like an aminosalicylate, since that type of medication is often used as a first-line treatment for a mild or moderate case of ulcerative colitis.

A corticosteroid like prednisone can also be used to treat flare-ups. However, medical experts do not recommend taking corticosteroids for extended periods of time because they can cause side effects.

Over time, you might realize that your current treatment isn’t working well enough for you. It might not be enough to prevent ulcerative colitis flare-ups or keep you in remission. First-line treatments like sulfasalazine and 5-aminosalicylates have a remission rate of about 50%, so it’s possible that they may not be enough.

Plus, for some people, ulcerative colitis can get worse over time. A 2022 study indicated that about one-quarter of participants with moderate UC tended to develop severe UC within 5 years. A medication that works for a moderate case might not be enough to treat a more severe case.

Do not assume that there’s nothing else that you can try if your treatment is not effective. An important next step can be speaking with your doctor and explaining that you’re not responding well enough to your current treatment plan. Describe how your symptoms have worsened and how they’re affecting your quality of life.

Then you can ask about trying one of the other medications. For example, biologics can be used to treat moderate to severe UC if other medications are not working well. Your doctor might also suggest taking a combination of medications, such as an immunosuppressant and a biologic at the same time.

It may take a little trial and error — and a little patience — to find the right medication.

There are more encouraging updates about ulcerative colitis treatments if you’re having difficulty finding one that’s effective for you. Scientists are constantly exploring new ways to treat inflammatory bowel diseases like ulcerative colitis. They’re looking at ways to improve the gut microbiome in a way that might make therapeutic treatments more effective.

Stem cell therapy also seems to hold some promise, according to research. The idea is that transplanted stem cells might help establish what’s essentially a new immune system in the intestine that can resist autoimmune attacks that cause inflammation.

A number of clinical trials are testing new treatment modalities, and you might be eligible to join one of them. Consider asking your doctor for help in finding more information. You can also contact the Crohn’s & Colitis Foundation to learn more about clinical trial opportunities.