Die Behandlung der Colitis ulcerosa heute und morgen

Treatment options for ulcerative colitis (UC) have expanded considerably in recent years and new options are constantly being added. There are two new studies on the use of TNF‑α inhibitors and vedolizumab. Both showed that there were higher rates of severe infections in patients aged > 60 years. Vedolizumab showed an equivalent response in patients < 40 years vs. > 60 years, while the rate of treatment failure was higher in older patients receiving TNF‑α. A recent study focused on treatment response in older patients receiving ustekinumab, with almost 70% of patients showing a clinical response after 16 weeks. A limiting factor in all studies is the small number of patients over 60 years of age. Recently, new recommendations from the European Crohnʼs and Colitis Organization (ECCO) regarding the management of CU patients during pregnancy and breastfeeding became available. Only five substances are now classified as contraindicated, so that there is now more certainty in this special situation, especially if the established therapy is to be maintained during pregnancy. The oral surveillance study caused concern in rheumatology; a direct healthcare professional communication warning is in place as there were safety signals regarding tofacitinib and major adverse cardiac events (MACE). The warning applies to the entire group of JAK, although these data have not yet been confirmed in gastroenterological cohorts. Nevertheless, data justify more cautious use in predisposed and especially older patients. Combination therapies are currently the topic of discussion, with initial data provided by the VEGA study, in which combination therapy of guselkumab with golimumab over 12 weeks demonstrated superiority in terms of clinical response and clinical remission as well as endoscopic improvement and normalization.