In the long and uneven history of treating chronic illness, a quiet possibility has surfaced from an unexpected shelf: common blood pressure medicines may help a costly therapy work better for people living with ulcerative colitis. Researchers at Northwestern and Kiel University, reporting in Nature Medicine, found that patients whose disease resisted vedolizumab often carried a pattern of inflammation in the blood vessels of the colon, and that the same pathway is touched by ACE inhibitors and ARBs. For young people whose days are shaped by urgency and bleeding, this is a hopeful thread, but
Blood Pressure Drugs May Boost Ulcerative Colitis Treatment Response, Northwestern-Led Study Finds
Ulcerative colitis patients, often teens or young adults, suffer daily symptoms including uncontrollable diarrhea and bloody stool, with complications leading to hospitalization and colon removal surgery.
Most patients do not achieve lasting remission with available treatments
Mark
So what's the headline here? Blood pressure pills might help colitis patients?
Mimi
Might help those on vedolizumab specifically. The team traced poor response to inflammation in the colon's blood vessels, and that pathway is what ACE inhibitors and ARBs already act on.
Mark
Why does that matter beyond the science?
Mimi
Because these patients are often teens and young adults, and Dulai describes bloody stool and diarrhea that keep them from school, work and social life. Most don't get lasting remission from current drugs.
Luke
Let me slow us down. The blood pressure finding comes from healthcare data on nearly 9,000 patients. That shows an association, not that the pills caused fewer hospitalizations.
Mimi
Fair. The authors themselves say clinical trials are needed to confirm it.
Mark
Did it work with every blood pressure drug?
Mimi
No. Other classes didn't show the same link, and ACE inhibitors or ARBs made no difference for patients on other colitis medications.
Luke
And everyone in that analysis had hypertension. Whether it helps people with normal blood pressure is unknown.
Mimi
Dulai says you wouldn't want to lower their pressure, so he points toward drugs designed to hit the pathway without that effect.
Mark
Anything else worth noting?
Luke
Takeda makes vedolizumab and provided trial data and support for the study. That's disclosed, and worth keeping in view.
Mimi
The team is also building a test to predict who will respond, which could spare patients months of symptoms.
Le Pouls
- Most people with ulcerative colitis still fail to reach lasting remission, even on expensive advanced therapies like vedolizumab.
- Researchers traced poor drug response to blood vessel inflammation, a pathway that inexpensive blood pressure medicines already reach.
- In nearly 9,000 hypertensive patients, those taking these drugs with vedolizumab had fewer hospitalizations and colon-removal surgeries.
- The findings remain observational, and clinical trials must confirm them before any change in treatment is considered for patients with normal blood pressure.
- A diagnostic test under development could identify in advance who will respond, sparing months of suffering on the wrong drug.
In the long and uneven history of treating chronic illness, a quiet possibility has surfaced from an unexpected shelf: common blood pressure medicines may help a costly therapy work better for people living with ulcerative colitis. Researchers at Northwestern and Kiel University, reporting in Nature Medicine, found that patients whose disease resisted vedolizumab often carried a pattern of inflammation in the blood vessels of the colon, and that the same pathway is touched by ACE inhibitors and ARBs. For young people whose days are shaped by urgency and bleeding, this is a hopeful thread, but a thread that still must be tested before anyone can be sure it will hold.
For many teenagers and young adults with ulcerative colitis, life narrows to bathroom urgency, bleeding, and the struggle to attend school, hold a job, or simply be with friends. Dr. Parambir Dulai, a senior author at Northwestern, compares the toll to that of cancer, and notes that most patients still do not achieve lasting remission, even with newer and expensive treatments like vedolizumab.
The research team, working with Dr. Stefan Schreiber of Kiel University, first examined data from more than 1,300 trial patients to map how their symptoms changed over time. They then studied tissue and blood samples and found that poor responders showed inflammation tied to the colon's blood vessels, a process already targeted by ACE inhibitors and angiotensin receptor blockers.
When they examined health records of nearly 9,000 people with both ulcerative colitis and high blood pressure, those taking vedolizumab alongside these blood pressure drugs were less likely to be hospitalized or need surgery. Other blood pressure medicines showed no such benefit, and the effect did not appear with other colitis drugs, pointing specifically to vedolizumab.
The researchers are careful about what remains unknown. Their data involve people who already had hypertension, and Dulai warned that these drugs should not be given to patients with normal blood pressure. He suggested that the same pathway might be reached by new medicines without the blood pressure effects, and his team is building a test that could help clinicians choose the right therapy from the start. The next step is clinical trials to determine whether these hopeful findings hold.
Researchers at Northwestern Medicine and Kiel University in Germany have found a possible way to make a widely used ulcerative colitis drug work better, and it may come from the pharmacy shelf rather than a new lab. Their study, published Nov. 9 in Nature Medicine, suggests that two common classes of blood pressure medication, ACE inhibitors and angiotensin receptor blockers (ARBs), may improve outcomes for patients taking vedolizumab, sold as Entyvio.
Ulcerative colitis is the most common type of inflammatory bowel disease. It is a chronic condition that causes inflammation and sores in the colon, and it affects more than 1 million people in the United States. It often begins in adolescence or young adulthood. Despite newer, advanced and expensive therapies like vedolizumab, most patients do not reach lasting remission with the treatments available.
Dr. Parambir Dulai, the study's senior author and an associate professor of medicine in gastroenterology and hepatology at Northwestern University Feinberg School of Medicine, described what that means for patients. They are teens or young adults with uncontrollable diarrhea and bloody stool, he said, who struggle to function at school or work or to go out and have normal social interactions. He said the psychosocial and physical toll may be on par with cancer.
The work unfolded in three steps. Dulai, Dr. Stefan Schreiber of Kiel University and colleagues first analyzed data from more than 1,300 patients enrolled in two clinical trials of vedolizumab for ulcerative colitis. By tracking how stool frequency and rectal bleeding changed over time, they identified distinct patterns of response to the drug.
Next, to understand why some patients resisted treatment, the team examined tissue biopsies and blood samples, measuring gene and protein activity. Two findings emerged. Poor response to vedolizumab was linked to a form of inflammation involving blood vessels in the colon. And that inflammation was tied to a biological pathway already targeted by ACE inhibitors and ARBs.
The third step tested whether those drugs make a difference in practice. The scientists analyzed healthcare data from nearly 9,000 people with both ulcerative colitis and high blood pressure. Among those on vedolizumab, patients also taking ACE inhibitors or ARBs were less likely to be hospitalized or to need surgery to remove the colon. Other classes of blood pressure drugs did not show the same association. The benefit also appeared specific to vedolizumab: patients taking ACE inhibitors or ARBs alongside other ulcerative colitis medications saw no difference.
The findings come with a clear limit. The data cover patients who already had hypertension, and the authors say clinical trials are needed to confirm the results and to learn how they might apply to people with normal blood pressure. Dulai was direct about that gap: it is not known whether such medications can be used in patients with normal blood pressure, and you would not want to give them a drug that lowers it. He suggested there may be other ways to hit the same pathway without those effects, and said the study gives a rationale for developing drugs designed for this purpose.
His team is also working on a diagnostic test built on the biological markers found in patients who did not respond to vedolizumab. Such a test could let clinicians identify beforehand who is likely to respond and who might do better with an alternative. That matters, Dulai said, because many patients starting these drugs suffer ongoing symptoms for months before finding one that works.
Other Northwestern co-authors are Cenfu Wei, Katherine Simpson, Zitong Lin, Isabella Peshek, Frida Chavez, Libeth Rosas and Alan Robinson. The study, titled "An ulcerative colitis taxonomy defined by individual patient-reported response trajectories," was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, the European Union's Innovative Medicines Initiative 2, the German Research Foundation and the German Federal Ministry of Education and Research. Takeda, which makes vedolizumab, provided access to clinical trial data and supported the study. The next marker to watch is whether controlled trials bear out the association.
Citations marquantes
Our study offers a rationale to start thinking about developing drugs specifically for this.— Dr. Parambir Dulai, Northwestern University Feinberg School of Medicine
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