Topical issues of therapy for patients with ulcerative colitis

Abstract

Ulcerative colitis is an autoimmune disease characterized by ulcerative destructive processes in the mucous membrane of the colon. Despite advances in the pharmaceutical industry, its prevalence in the world is increasing every year. The etiology of UC is currently unknown to the end. According to modern concepts, ulcerative colitis is considered as a multifactorial disease, in the pathogenesis of which genetic determinism, disorders of the intestinal microbiota with a decrease in populations of anaerobic bacteria in combination with the trigger action of environmental factors are discussed. With high probability, the leading pathogenetic mechanisms of the disease are associated with the polarization of the Th2-type immune response, which is characterized by the synthesis of IL-4, IL-5, IL-9 and IL-13, which is regulated by STAT-5 and Gata-3. During the development of the disease, Th17, a type of immune response, is also involved in the immunopathological process, but with the participation of transcription factors STAT-3 and ROR-yt and the synthesis of IL-17, IL-2, IL-6, IL-26 and IL-22, as well as chemokine CCL20. Diet and lifestyle are part of the global guidelines for the treatment of patients with ulcerative colitis. Derivatives of 5-aminosalicylic acid are used as basic therapy preparations: combined preparations and preparations of pure 5-aminosalicylic acid. Nevertheless, the administration of systemic glucocorticosteroids is indicated to control the activity of the disease. However, as our practice shows, they are effective, but only at the first attack and subsequent 2-3 relapses of the disease, followed by a high incidence of hormone resistance. To date, there are modern medicines with a different mechanism of action, allowing achieving stable remission and improving the quality of life of patients. Among them, JAK -tofacitinib inhibitors are of particular interest in the treatment of ulcerative colitis. This is the first oral drug capable of inducing and maintaining steroidal remission. The choice of a particular drug is determined by the experience of use, cost and national recommendations.