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Chinese Herbal Retention Enema for the Treatment of Ulcerative Colitis
Published on: May 16, 2025
An evaluation of guselkumab for the treatment of ulcerative colitis
Jurij Hanzel1,2, Vipul Jairath2,3,4, Brian G Feagan2,3,4
1Department of Gastroenterology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Introduction:
Interleukin (IL)-23 is a cytokine implicated in the pathogenesis of ulcerative colitis (UC). Guselkumab, a selective IL-23 antagonist, was approved for the treatment of moderately-to severely active UC in 2024/5.
Areas Covered:
The review briefly summarizes the pathophysiology of the IL-23 pathway and summarizes the available evidence on the efficacy and safety of guselkumab in UC. We discuss future challenges and clinical dilemmas in the use of guselkumab.
Expert Opinion:
Guselkumab has demonstrated efficacy across all endpoints with a favorable safety profile. No direct comparisons are available between individual IL-23 antagonists or with ustekinumab, the IL-12/23 antagonist, which limits decision-making in clinical practice. Combining two biologics as advanced combination treatment is an attractive strategy to break the therapeutic efficacy ceiling in UC - a proof-of-concept phase 2 trial combining guselkumab and golimumab has shown promise, the combination is currently undergoing evaluation in a larger ongoing trial.
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