The Difference in Treating Flares vs. Chronic UC

So we have many different medications that work to treat ulcerative colitis. We break them down into different categories and also for different indications.

So we have some agents that work really only to treat the acute flare, the current symptoms, to get patients better quickly. But because of long term side effects, we tend not to use them other than for maybe three months max in order to reduce the acute symptoms.

These things would include primarily prednisone, which work very quickly but, again, have very, very severe long term side effects. Most of the agents that we use for treating ulcerative colitis work both for induction of remission so getting the acute symptoms better but also for maintenance every of remission to keep someone well. So once we identify that a patient responds to those agents, we will tend to continue them on those agents to maintain remission.

So a good example of this would be our biologic agents. We use them both to induce a very rapid remission but also to maintain that remission over time. And you will see doctors checking drug levels and adjusting the medications in order to maintain remission, hopefully indefinitely.

When someone responds to a medicine, in general that's the medicine that they need to stay on to stay well. Now, we do over time as we get to that point, the mucosal healing and the colon goes back to normal, and they're feeling well, we do try to peel back medications in order to make it more simple for the patient, and also to reduce risk. So a good example of that would be if you start someone on what we call combination therapy.

After they've been on medicine for a while and we've gotten them better, we may peel off the immunomodulator to reduce risk once we've gotten over that initial hump. It's also important to realize that just because one dose of the medicine worked at time A, it may require adjustments to that dose to keep the patient in remission. There's a tendency over time for patients maybe to clear the drug a little bit more quickly. And so adjusting the dose, checking drug levels, are really important to maintain that remission.