Treatment update 2022: ulcerative colitis

Ulcerative colitis, which affects over 300,000 people in Germany, is associated with costs of over 10 billion euro /year. Therapeutic goals are clinical remission, avoidance of structural damage (mucosal and histological healing), and good quality of life. Therefore, treatment stratification based on risk factors is recommended (young age at diagnosis, deep ulcers, extensive colitis, malnutrition, and refractory course). When refractory flares occur infections must be ruled out, particularly cytomegalovirus (CMV) and clostridium difficile. Apart from steroids (only for flares), aminosalicylates are used, while thiopurines are used only for maintenance therapy. In addition to infliximab (a monoclonal antibody directed against tumor necrosis factor [TNF]-alpha), the biologics vedolizumab, and ustekinumab are available. New alternatives are small molecules, i.e., Janus kinase inhibitors (tofacitinib, filgotinib, upadacitinib) and the sphingosine 1 phosphate modulator ozanimod. Contraindications and the respective adverse events profile need to be kept in mind.