Medication is the first line of treatment for ulcerative colitis. Your doctor’s recommendation for which medication will work best for you is based on the severity of your disease, your overall health, and other individual factors.

There are six major classes of medication used to treat ulcerative colitis. Visit our IBD Medication Guide to view a comprehensive listing of all available medications for ulcerative colitis.

Aminosalicylates (5-ASA)

Aminosalicylates are medications that contain 5-aminosalicylic acid (5-ASA) and work in the lining of the gastrointestinal tract to decrease inflammation. Aminosalicylates work best in the colon and are often given orally in the form of delayed release tablets, or rectally as enemas or suppositories.

Aminosalicylates are thought to be effective in treating mild-to-moderate ulcerative colitis flares and can be useful as a maintenance treatment in preventing relapses of the disease.

Examples:

• Sulfasalazine

• Mesalamine

• Olsalazine

• Balsalazide

Corticosteroids

Corticosteroids suppress the immune system and are used to treat moderate to severely active ulcerative colitis. These drugs work non-specifically, meaning that they suppress the entire immune response, rather than targeting specific parts of the immune system that cause inflammation. These medications are available orally and rectally.

Corticosteroids have significant short and long-term side effects and should not be used as a maintenance medication. Because they cause the adrenal glands to slow or even stop producing the body’s natural cortisol, these medications cannot be stopped abruptly.

If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to prescribe other medications to help manage your disease.

Examples:

• Prednisone

• Prednisolone

• Methylprednisolone

• Budesonide

Immunomodulators

This class of medication controls or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators, which may take several months to begin working, are generally are used when aminosalicylates and corticosteroids haven’t been effective, or have been only partially effective.

These medications may be useful in reducing or eliminating the need for corticosteroids, and in maintaining remission in people who haven’t responded to other medications given for this purpose. Some immunomodulators are used to make other medications, such as biologics, work better.

Examples:

• Azathioprine

• 6-mercaptopurine

• Cyclosporine

• Tacrolimus

Targeted Synthetic Small Molecules

Targeted synthetic small molecules are medications that help reduce inflammation by specifically targeting parts of the immune system. The targets of these medications can play a role in intestinal inflammation. These medications are taken by mouth and they are indicated for adult patients with moderate to severely active ulcerative colitis.

Examples:

• Ozanimod
• Tofacitinib
• Upadacitinib
• Etrasimod

Biologic/Biosimilar Therapies

Biologics are used to treat people with moderate-to-severe ulcerative colitis. Unlike other medications, biologics are protein-based therapies that are created out of material naturally found in life. These medications are antibodies that stop certain proteins in the body from causing inflammation.

Examples:

• Adalimumab

• Golimumab

• Infliximab

• Ustekinumab

• Vedolizumab

• Mirikizumab-mrkz

Biosimilars are nearly identical copies of other already approved biologic therapies. They have the same effectiveness and safety as the originally approved biological therapy, which is called the originator drug or reference product.

Examples:

• Infliximab-abda

• Infliximab-dyyb

• Infliximab-qbtx

• Adalimumab-atto

• Ustekinumab-auub