How effective are the usual treatments for ulcerative colitis?

BACKGROUND

Details of the efficacy of the drugs used in ulcerative colitis are not readily available.

METHODS

We have reviewed all placebo-controlled trials of the commonly used drugs for both induction and maintenance of remission to determine the efficacy and to calculate the numbers needed to treat (NNTs) to achieve a specified benefit for each drug.

RESULTS

The drug response rates and the NNTs (with 95% CI) are tabulated for each drug.

CONCLUSION

Corticosteroids give a remission rate of 68% in mild or moderate disease and an NNT for remission of 2 (95% CI 1.4-5) in mild disease. Intravenous hydrocortisone gives a remission rate of 60-73%. Aminosalicylates are relatively ineffective in inducing remission with an NNT of 10 (95% CI 7-21) improving to 8 (95% CI 5-20) if the dose > or = 3 g daily. They are better at maintenance (NNT = 6; 95% CI 4-8). Intravenous ciclosporin is very effective in achieving remission in severe colitis with an NNT of 1.2 (95% CI 1-2.5). Although there is fairly good evidence that azathioprine is effective in maintaining remission and is used widely, there are no suitable placebo-controlled trials to calculate the NNT.