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You and your doctor already have a variety of treatment options available for ulcerative colitis (UC), but science marches on, with the pharmaceutical industry close behind. Dozens of novel therapies are currently in development. Not all of them will ultimately win approval, but if you should ever need a change in treatment, you can be assured that the range of possibilities will grow ever greater.

Here are some of the new approaches now being tested.

Drugs Already Available for Other Conditions

Most of the modern drugs for UC were first approved for other conditions such as rheumatoid arthritis or psoriasis, thanks to similarities in the underlying disease processes, and that trend is likely to continue. A number of other medications already on the market, with well-established safety records, are currently being studied to gain approvals for UC. These include:

• Risankizumab (Skyrizi), now approved for psoriasis, psoriatic arthritis, and Crohn's disease

• Guselkumab (Tremfya), now approved for psoriasis

• Deucravacitinib (Sotyktu), now approved for psoriasis

• Spesolimab (Spevigo), now approved for pustular psoriasis

Variations on Existing Products

Once a new type of product succeeds in clinical use, the pharmaceutical industry will try to improve on it -- designing "me too" products that do basically the same thing but hopefully with fewer side effects and/or stronger efficacy. Thus, drug companies are now testing drugs intended to follow in the footsteps of such popular medications as adalimumab (Humira), vedolizumab (Entyvio), and ozanimod (Zeposia).

New Drug Classes

Scientists have been hard at work exploring details of what goes wrong in UC. This research has suggested a wide variety of novel ways to attack UC. It's too early to say with confidence which will lead to useable drugs, since testing often reveals unexpected side effects (which itself may highlight new avenues to explore). However, examining the U.S. government's registry of clinical trials shows 10 entirely novel products that have already passed the initial safety testing and are in mid- or late-stage evaluation.

Beyond Synthetic Drugs

The jury is still out on whether the "intestinal microbiome" -- the collection of beneficial (mostly) bacteria that lives in the normal intestine and is critical for proper digestion -- is involved in causing UC or exacerbating its symptoms. But studies have documented that the microbiome is altered in UC, such that it makes sense to see whether normalizing it can restore normal bowel appearance and function.

One way to do this is by altering the intestinal habitat to encourage a healthier mix of bacteria (e.g., "prebiotics"); another is to deliver batches of specific healthy bacterial species ("probiotics"). A third approach is to replace the UC patient's microbiome with one from healthy people via fecal transplant. Many trials have already been conducted with mixed results, and more are in process. Whether these will prove to be viable treatments remains to be seen, but they certainly bear watching.

Read previous installments in this series:

For Your Patients: What Is Ulcerative Colitis?

For Your Patients: I've Had Diarrhea That Won't Go Away -- What Should I Do?

For Your Patients: UC -- Why Me?

For Your Patients: Starting Drug Therapy for Ulcerative Colitis

For Your Patients: Diet and Lifestyle Considerations

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

For Your Patients: Living With Ulcerative Colitis

For Your Patients: Would Surgery Help My Ulcerative Colitis?

For Your Patients: Possible Long-Term Complications of Ulcerative Colitis

"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.