The role of biologics in ulcerative colitis

Since the introduction of anti-TNF agents for the treatment of Crohn's disease there has been interest in the potential for treating ulcerative colitis with biological therapies. Early observational series suggested a benefit in the setting of severe, hospitalized patients. However, the recent completion of two large multi-center, double-blind placebo-controlled trials confirmed a role for infliximab for outpatients with refractory, moderate-severe disease with evidence for clinical remissions, mucosal healing, and a reduction in colectomies. Despite this evidence, there are numerous questions remaining regarding the optimal positioning in the setting of moderate-severe disease, potential benefits of concomitant immune suppression and the need for maintenance treatment after induction therapy. Additional clinical trials have demonstrated a less profound benefit for adalimumab at similar doses that are used in Crohn's disease. Other biological agents that have targeted T cells such as visiluzimab and abatacept were not demonstrated to be effective in controlled trials.