Treatment of ulcerative colitis: focus on the adherence to therapy

Abstract

Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. The aim of management is to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. There are multiple classes of drugs that are available and are used based on the clinical severity of the disease. For mild‑to‑moderate disease, oral or rectal formulations of 5‑aminosalicylic acid are used. Oral 5‑ASA is an established treatment for ulcerative colitis and the current standard of care for most patients requiring long‑term maintenance treatment throughout their lives. However, adherence rates — especially in patients in remission — remain low. It is now becoming relevant to find tools that improve patient adherence to treatment, as it has been found that multiple dosing is a predictor of non‑compliance in IBD and is related to a significantly increased risk of ulcerative colitis. Dosing of 5‑АSA once a day has similar efficacy to divided doses and could increase adherence. Asacol consists of a pellet of 5‑АSA destined for release in the terminal ileum or colon due to a coating known as EudragitS, a resin that dissolves at a pH greater than 7. Asacol is an effective and well‑tolerated initial therapy in patients with mildly to moderately active ulcerative colitis.