Nonbiologic Immune Suppression in Ulcerative Colitis

Valérie Heron, Edward V. Loftus

Research output: Contribution to journalReview articlepeer-review


This article reviews nonbiologic immunosuppressive agents in the induction and maintenance of remission of ulcerative colitis. Based on meta-analyses and North American guidelines, azathioprine, mercaptopurine, and methotrexate monotherapy are not recommended for induction therapy. Thiopurines are recommended in combination with infliximab. Tofacitinib has been shown to be an effective induction agent. Cyclosporine or tacrolimus are calcineurin inhibitors that can be used as induction therapy. Thiopurine monotherapy is suggested or recommended as maintenance therapy for patients who have achieved steroid-induced remission. Methotrexate monotherapy is not recommended. Tofacitinib has been shown to be an effective maintenance agent in moderate to severe disease.

Original languageEnglish (US)
Pages (from-to)731-738
Number of pages8
JournalGastroenterology Clinics of North America
Issue number4
StatePublished - Dec 2020


  • Azathioprine
  • Cyclosporine
  • Mercaptopurine
  • Methotrexate
  • Tacrolimus
  • Tofacitinib
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology


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