This article reviews the role of
corticosteroids,
sulfasalazine and
mesalazine (
5-aminosalicylic acid,
mesalamine),
immunosuppressive agents and alternative novel drugs for the treatment of distal
ulcerative colitis. Short cycles of traditional, rectally administered
corticosteroids (
methylprednisolone,
betamethasone,
hydrocortisone) are effective for the treatment of mild to moderately active distal
ulcerative colitis. In this context, their systemic administration is limited to patients who are refractory to either oral 5-amino-salicylates, topical
mesalazine or topical
corticosteroids. Of no value in maintaining remission, the long term use of either or topical
corticosteroids may be hazardous. A new class of topically acting
corticosteroids [
budesonide,
fluticasone,
beclomethasone dipropionate, prednisolone-21-methasulphobenzoate,
tixocortol (
tixocortol pivalate)] represents a valid alternative for the treatment of active
ulcerative colitis, and may be useful in the treatment of refractory distal
ulcerative colitis. Although there is controversy concerning dosage or
duration of therapy, oral and topical
mesalazine is effective in the treatment of mild to moderately active distal
ulcerative colitis.
Sulfasalazine and
mesalazine remain the first-choice drugs for the maintenance
therapy of distal
ulcerative colitis. Evidence exists showing a trend to a higher remission rate with higher doses of oral
mesalazine. Topical
mesalazine (
suppositories or
enemas) also is effective in maintenance treatment. For patients with chronically active or
corticosteroid-dependent disease,
azathioprine and
mercaptopurine are effective in reducing either the need for
corticosteroids or clinical relapses. Moreover, they are effective for long term maintenance remission.
Cyclosporin may be useful in inducing remission in patients with acutely severe disease who do not achieve remission with an intensive intravenous regimen. Existing data suggest that
azathioprine and
mercaptopurine may be effective in prolonging remission in these patients. The role of alternative drugs for the treatment of distal
ulcerative colitis and its different forms is reviewed. In particular data are reported concerning the effectiveness of
5-lipoxygenase inhibitors, topical use of
short chain fatty acids,
nicotine, local anaesthetics,
bismuth subsalicylate enema,
sucralfate,
clonidine,
free radical scavengers,
heparin and
hydroxychloroquine.