The primary goals of pharmacotherapy in UC are to induce remission during acute flares and to maintain long-term corticosteroid-free remission, once remission is achieved. UC treatment regimens are broadly divided into acute and maintenance therapy. Acute therapies are used to induce remission and to inhibit the inflammatory process, whereas maintenance therapies support remission and prevent acute flares. The treatment of UC generally starts with conventional small molecules like 5-ASAs, which are the mainstay of UC treatment. Patients not controlled on 5-ASAs are commonly prescribed corticosteroids and immunosuppressants. Biologics are generally reserved for uncontrolled moderate to severe UC patients, and surgery is the last resort when a UC patient does not respond to any treatments. Among the biologics, TNF-α inhibitors—especially Remicade and Humira—are the most prescribed drugs. The recent launch of biosimilar infliximab—a less-expensive alternative to Remicade—has altered how some physicians make their prescribing decisions for TNF-α inhibitors. The launch of drugs with newer MOAs, including the CAM inhibitor Entyvio, has further impacted the UC treatment landscape.


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