For Your Patients: My Ulcerative Colitis Treatment Isn't Working. Now What?

You've been taking the medication that your doctor first recommended after your diagnosis of ulcerative colitis (UC). Now, a few months later, you find yourself still battling symptoms, or they subsided for awhile but have now returned. What can you expect from your doctor now?

He or she will probably want to conduct another round of tests to see what's going on. If you did have symptom remission, it's possible that you've developed some other condition such as an infection whose symptoms mimic UC. Or it may be that blood levels of your medication aren't high enough to be effective. The results will help your doctor determine the best approach.

In most cases where symptoms don't respond to initial treatment, or you find the side effects intolerable, a change in medication is called for. Assuming your condition hasn't become markedly worse from before, here are some of the options your doctor may propose:

• Increased dosage of your current drug (if previously tolerated)

• Switching to a different drug in the same class

• Changing from oral medication to a suppository

• Adding a second drug such as a steroid or immunosuppressant

Most patients can achieve durable remission with one or more of these steps. However, if your symptoms persist or continue to worsen, your doctor may recommend one of the newer types of drugs for UC, which include:

• Tumor necrosis factor (TNF) inhibitors (infliximab, adalimumab, golimumab) -- infusion or shots

• Janus-associated kinase (JAK) inhibitors (tofacitinib, upadacitinib) -- pill

• Anti-adhesion molecule (vedolizumab) -- infusion

• Interleukin-12/23 inhibitor (ustekinumab) -- infusion and shots

• Sphingosine-1-phosphate receptor agonist (ozanimod) -- pill

These drugs act on very specific parts of the immune system to prevent it from attacking cells in the intestine (the root cause of UC, as explained in earlier installments in this series). They are very effective, but you may face higher out-of-pocket costs. These medications also increase the risk of certain infections such as tuberculosis -- still rare but something to consider when discussing the options with your doctor.

A key point is if you do not feel your symptoms are under control, be sure to talk with your gastroenterologist. There are multiple medication options available and some patients require several medications to find one that brings their disease under control.

Read previous installments in this series:

What Is Ulcerative Colitis?

I've Had Diarrhea That Won't Go Away -- What Should I Do?

UC -- Why Me?

Starting Drug Therapy for Ulcerative Colitis

Diet and Lifestyle Considerations

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.