Editing Ulcerative colitis (section)

====Biologics====
Biologic treatments such as the [[TNF inhibitor]]s [[infliximab]], [[adalimumab]], and [[golimumab]] are commonly used to treat people with UC who are no longer responding to corticosteroids. [[Tofacitinib]] and [[vedolizumab]] can also produce good clinical remission and response rates in UC.<ref name=Hir2015/> Biologics may be used early in treatment (step down approach), or after other treatments have failed to induce remission (step up approach); the strategy should be individualized.<ref>{{cite journal | vauthors = Salahudeen MS | title = A review of current evidence allied to step-up and top-down medication therapy in inflammatory bowel disease | journal = Drugs of Today | volume = 55 | issue = 6 | pages = 385–405 | date = June 2019 | pmid = 31250843 | doi = 10.1358/dot.2019.55.6.2969816 | s2cid = 195763151 }}</ref>

Unlike aminosalicylates, biologics can cause serious side effects such as an increased risk of developing extra-intestinal cancers,<ref name=AxelradLichtiger2016>{{cite journal | vauthors = Axelrad JE, Lichtiger S, Yajnik V | title = Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment | journal = World Journal of Gastroenterology | volume = 22 | issue = 20 | pages = 4794–4801 | date = May 2016 | pmid = 27239106 | pmc = 4873872 | doi = 10.3748/wjg.v22.i20.4794 | type = Review | doi-access = free }}</ref> [[heart failure]]; and weakening of the immune system, resulting in a [[Immunodeficiency|decreased ability of the immune system to clear infections]] and reactivation of latent infections such as [[tuberculosis]]. For this reason, people on these treatments are closely monitored and are often tested for hepatitis and tuberculosis annually.<ref>{{cite journal | vauthors = Stevens JP, Ballengee CR, Chandradevan R, Thompson AB, Schoen BT, Kugathasan S, Sauer CG | title = Performance of Interferon-Gamma Release Assays for Tuberculosis Screening in Pediatric Inflammatory Bowel Disease | journal = Journal of Pediatric Gastroenterology and Nutrition | volume = 69 | issue = 4 | pages = e111–e116 | date = October 2019 | pmid = 31261245 | doi = 10.1097/MPG.0000000000002428 | s2cid = 195771593 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Lee CK, Wong SH, Lui G, Tang W, Tam LS, Ip M, Hung E, Chen M, Wu JC, Ng SC | title = A Prospective Study to Monitor for Tuberculosis During Anti-tumour Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease and Immune-mediated Inflammatory Diseases | journal = Journal of Crohn's & Colitis | volume = 12 | issue = 8 | pages = 954–962 | date = July 2018 | pmid = 29757355 | doi = 10.1093/ecco-jcc/jjy057 | s2cid = 21673794 | doi-access = free }}</ref>

Etrasimod, a once-daily oral sphingosine 1-phosphate (S1P) receptor modulator that selectively activates S1P receptor subtypes 1, 4, and 5 with no detectable activity on S1P 2 or 3, is in development for treatment of immune-mediated diseases, including ulcerative colitis, and was shown in 2 randomized trials to be effective and well tolerated as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis.<ref>{{cite journal |last1=Sandborn |first1=William J. |last2=Vermeire |first2=Séverine |last3=Peyrin-Biroulet |first3=Laurent |last4=Dubinsky |first4=Marla C. |last5=Panes |first5=Julian |last6=Yarur |first6=Andres |last7=Ritter |first7=Timothy |last8=Baert |first8=Filip |last9=Schreiber |first9=Stefan |last10=Sloan |first10=Sheldon |last11=Cataldi |first11=Fabio |last12=Shan |first12=Kevin |last13=Rabbat |first13=Christopher J. |last14=Chiorean |first14=Michael |last15=Wolf |first15=Douglas C. |date=8 April 2023 |title=Etrasimod as induction and maintenance therapy for ulcerative colitis (ELEVATE): two randomised, double-blind, placebo-controlled, phase 3 studies |journal=The Lancet |language=English |volume=401 |issue=10383 |pages=1159–1171 |doi=10.1016/S0140-6736(23)00061-2 |issn=0140-6736 |pmid=36871574|s2cid=257286271 |doi-access=free }}</ref>