New Hope For Ulcerative Colitis: A Deep Dive Into Xeljanz, Velsipity, And More

Having ulcerative colitis (UC) is comparable to fighting a never-ending war. The belly aches, constant trips to the bathroom, and exhaustion can take everything out of you, so doing ordinary things is difficult. For the millions of people who have this inflammatory bowel disease, having effective treatments is a turning point. Luckily, recent advancements in medications like Xeljanz and Velsipity are opening new doors, and drugs like Rexulti and Libtayo make the rounds every now and then in UC treatment discussions. Let's take a closer look at the treatments, their mechanisms of action, and what they promise for UC patients.

What Is Ulcerative Colitis, and Why Is Treatment So Important?

Ulcerative colitis is more than just a digestive issue—it’s an autoimmune condition where your immune system mistakenly attacks the lining of your colon, causing inflammation and painful ulcers. This leads to symptoms like diarrhea, rectal bleeding, and cramping, which can flare up unpredictably and then fade into periods of calm. In the U.S., about 1.25 million people live with UC, and globally, the numbers are even higher.

These symptoms don’t just affect your body; they can take a toll on your mental health and social life, too. Plus, over time, UC can raise your risk of serious complications like colorectal cancer. Traditional treatments like steroids or aminosalicylates work for some, but for those with moderate to severe UC, they often fall short. That’s where newer, targeted therapies come in, offering relief without the need for constant injections or infusions.

Xeljanz: A Game-Changing Pill for UC

Imagine a treatment for UC that doesn’t involve needles or hospital visits—just a pill you take twice a day. That’s Xeljanz (tofacitinib), a groundbreaking medication from Pfizer that became the first oral drug approved by the FDA in 2018 for moderate to severe UC. Xeljanz is a JAK inhibitor, which means it blocks specific enzymes (called Janus kinases) that fuel inflammation in your body. By calming this overactive immune response, it helps soothe the colon and keeps symptoms at bay.

Does It Work?

The proof is in the numbers. In clinical trials, Xeljanz showed impressive results. In two 8-week studies, 17–18% of patients taking 10 mg twice daily were in remission by week 8, compared to just 4–8% on a placebo. A year-long trial found that 34% of patients on a 5 mg dose and 41% on a 10 mg dose stayed in remission, with many able to ditch steroids entirely. Even better, a 36-month study showed that 68% of patients on the lower dose hit remission, and about half stayed there long-term.

How Do You Take It?

Xeljanz comes in 5 mg or 10 mg tablets, typically taken twice a day, or as extended-release (XR) tablets (11 mg or 22 mg) taken once daily. Most patients start with a higher dose for 8–16 weeks to get symptoms under control, then switch to a lower maintenance dose. If you have kidney or liver issues, your doctor might tweak the dose.

What About Side Effects?

Like any powerful drug, Xeljanz has risks. Common side effects include headaches, diarrhea, or a stuffy nose. More serious concerns include infections, blood clots, or a slight risk of certain cancers, which is why it carries an FDA warning. You shouldn’t take it with biologics or strong immune-suppressing drugs, and live vaccines are off-limits. If you’re pregnant or planning to be, talk to your doctor, as you’ll need to use contraception while on it.

Velsipity: The New Kid on the Block

Fast forward to October 2023, and we have Velsipity (etrasimod), another oral option from Pfizer that’s making waves. Velsipity is an S1P receptor modulator, a fancy way of saying it traps inflammation-causing immune cells in your lymph nodes so they can’t wreak havoc in your colon. This helps reduce inflammation and even promotes healing in the gut’s lining.

How Well Does It Work?

Velsipity’s approval came after two major trials called ELEVATE UC 52 and ELEVATE UC 12. In the 52-week study, 27% of patients were in remission by week 12 (compared to 7% on placebo), and 32% stayed there by week 52. The shorter 12-week trial saw 26% of patients hit remission versus 15% on placebo. These trials also showed benefits like better endoscopic results and healed gut tissue, even in patients with tough-to-treat cases like isolated proctitis.

How Do You Take It?

It’s simple: one 2 mg tablet a day, with or without food. For the first three days, take it with food to avoid any heart rate dips. Before starting, you’ll need some baseline tests—blood work, liver function, heart, and eye exams, plus a check on your vaccinations.

Any Downsides?

Most side effects are mild, like headaches or dizziness, but about 11% of patients experience low lymphocyte counts. Velsipity can affect your heart rhythm at first, so it’s not for people with recent heart issues. It’s also under extra scrutiny by regulators, so you’ll get detailed info to use it safely.

Rexulti and Libtayo: Why Are They Mentioned?

You might’ve heard Rexulti or Libtayo tossed around in UC discussions, but neither is approved for this condition. Here’s the deal:

Rexulti (brexpiprazole) is a mental health drug used for depression and schizophrenia. It tweaks dopamine and serotonin in the brain, which doesn’t help with UC’s inflammation. That said, UC can be emotionally draining, and some patients might take Rexulti for anxiety or depression alongside their UC treatment. It’s not a gut fix, though.
Libtayo (cemiplimab) is an immunotherapy drug for cancers like skin or lung cancer. It boosts the immune system to fight tumors, but there’s no evidence it helps with UC. Its mention might come from confusion or early research into immune-based therapies, but it’s not part of the UC playbook.

If you see these names floating around, double-check with your doctor—they’re likely not relevant to your UC treatment plan.

The Bigger Picture: Where Do These Drugs Fit?

The UC treatment world is buzzing with options. Xeljanz and Velsipity are part of a growing wave of oral drugs competing with heavy-hitters like biologics (think Humira, Stelara, or Entyvio). Other oral players, like Bristol Myers Squibb’s Zeposia or AbbVie’s Rinvoq, are also in the mix, while new biologics like Lilly’s Omvoh are shaking things up. Velsipity stands out for not needing a ramp-up dose, and patients love the convenience of pills over injections.

Cost is a hurdle—Velsipity runs about $75,000 a year—but insurance and patient assistance programs can help. Doctors often see these oral drugs as a step before biologics, especially for patients who want to avoid needles. Looking ahead, researchers are exploring new pathways and even testing drugs like Velsipity for other conditions like Crohn’s disease or dermatitis.

What This Means for You

For anyone with UC, the arrival of Xeljanz and Velsipity is a big deal. These pills offer a convenient, effective way to manage symptoms and aim for remission without the hassle of infusions. While Rexulti and Libtayo don’t belong in the UC treatment toolbox, the focus on Xeljanz and Velsipity shows how far we’ve come in giving patients more control over their condition.

If you’re curious about these treatments, talk to your gastroenterologist. They can help you weigh the benefits and risks based on your symptoms and health history. You can also check out resources like the Crohn’s & Colitis Foundation or Pfizer’s Velsipity website for more details.

Living with UC isn’t easy, but with options like these, there’s real hope for calmer days and a better quality of life.