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The role of mesalamine in the treatment of ulcerative colitis.

Karagozian R, Burakoff R - Ther Clin Risk Manag (2007)

Bottom Line: Newer formulations of salicylates based drugs with fewer side-effects have been developed.In the setting of left-sided distal colitis (proctitis), topical (rectal) formulations have been found to be superior to oral aminosalicylates at inducing remission.Mesalamine has been shown to be safe in short term use with a dose-response efficacy without dose-related toxicity.

View Article: PubMed Central - PubMed

Affiliation: Brigham and Women’s Hospital, Harvard Medical School Boston, MA, USA.

ABSTRACT
Ulcerative colitis (UC) is a chronic inflammatory condition of unclear etiology affecting the large bowel, most commonly the rectum and extending proximally in a continuous fashion. The overall principle in the pathophysiolgy of ulcerative colitis is the dysregulation of the normal immune system against an antigenic trigger leading to a prolonged mucosal inflammatory response. The diagnosing of UC is made by combining the clinical picture, tissue biopsy with the endoscopic appearance of mucosal ulceration, friable, edematous, erythematous granular appearing mucus. The approach to therapy of UC has been dependent on severity of symptoms with frontline therapy being salicylate based sulfasalazine. Newer formulations of salicylates based drugs with fewer side-effects have been developed. These are free of the sulphur component and are composed of 5-ASA, without the sulfapyridine carrier molecule. Mesalamine is one of these 5-ASA based agents that are currently available and indicated for treatment of UC. In mild/moderate active disease mesalamine has response rates between 40%-70% and remission rates of 15%-20%. Considering that the efficacy of 5-ASA is dose dependent, 4.8 g/day and 2.4 g/day have been shown to be the optimal dosages for mild-moderate distal active disease and for maintenance therapy, respectively. Patients with moderately active ulcerative colitis treated with 4.8 g/d of mesalamine are significantly more likely to achieve overall improvement at week 6 compared to patients treated with 2.4 g/d. In the setting of left-sided distal colitis (proctitis), topical (rectal) formulations have been found to be superior to oral aminosalicylates at inducing remission. Mesalamine has been shown to be safe in short term use with a dose-response efficacy without dose-related toxicity.

No MeSH data available.


Related in: MedlinePlus

The combination therapy of oral and enema mesalamine treatment was shown to be superior to oral alone in terms of both remission and improvement. Improvement was defined by objective scoring method based on disease activity. Improvement was obtained in 89% of mesalamine group versus 62% of placebo group at week 4 (p = 0.0008). At week 8, 86% of mesalamine enema group versus 68% of placebo group (p = 0.026) showed improvement. Adapted from data: Marteau et al (2004).
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fig4: The combination therapy of oral and enema mesalamine treatment was shown to be superior to oral alone in terms of both remission and improvement. Improvement was defined by objective scoring method based on disease activity. Improvement was obtained in 89% of mesalamine group versus 62% of placebo group at week 4 (p = 0.0008). At week 8, 86% of mesalamine enema group versus 68% of placebo group (p = 0.026) showed improvement. Adapted from data: Marteau et al (2004).

Mentions: In patients with extensive mild/moderate active UC defined by involvement beyond the splenic flexure, Marteau et al (2005) demonstrated adding a mesalamine enema to an oral regimen would provide additional benefit for patients with extensive mild/moderate active UC. A randomized double blind study was conducted in 127 ambulatory patients receiving 4 g/day oral mesalamine. Patients were randomized to either receiving 1 g mesalamine enema nightly versus placebo and disease activity was assessed at 4 and 8 weeks. Disease activity was assessed using endoscopic signs of improvement and clinical features of response. Briefly, clinical and endoscopic features of response include decrease stool frequency, decrease episodes of rectal bleeding, physician global assessment, and decreased erythema, friability, and ulcerations on endoscopy. Objective scoring system was established for different stages of the clinical features and accordingly the endpoints of remission and clinical improvement were defined. The combination therapy of oral and enema mesalamine treatment was shown to be superior to oral alone in terms of both remission and improvement. Improvement was obtained in 89% of mesalamine enema group versus 62% of the placebo group at week 4 (p = 0.0008). At week 8, 86% of the mesalamine enema group versus 68% of the placebo group (p = 0.026) showed improvement (Marteau et al 2005) (see Figure 4).


The role of mesalamine in the treatment of ulcerative colitis.

Karagozian R, Burakoff R - Ther Clin Risk Manag (2007)

The combination therapy of oral and enema mesalamine treatment was shown to be superior to oral alone in terms of both remission and improvement. Improvement was defined by objective scoring method based on disease activity. Improvement was obtained in 89% of mesalamine group versus 62% of placebo group at week 4 (p = 0.0008). At week 8, 86% of mesalamine enema group versus 68% of placebo group (p = 0.026) showed improvement. Adapted from data: Marteau et al (2004).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2376091&req=5

fig4: The combination therapy of oral and enema mesalamine treatment was shown to be superior to oral alone in terms of both remission and improvement. Improvement was defined by objective scoring method based on disease activity. Improvement was obtained in 89% of mesalamine group versus 62% of placebo group at week 4 (p = 0.0008). At week 8, 86% of mesalamine enema group versus 68% of placebo group (p = 0.026) showed improvement. Adapted from data: Marteau et al (2004).
Mentions: In patients with extensive mild/moderate active UC defined by involvement beyond the splenic flexure, Marteau et al (2005) demonstrated adding a mesalamine enema to an oral regimen would provide additional benefit for patients with extensive mild/moderate active UC. A randomized double blind study was conducted in 127 ambulatory patients receiving 4 g/day oral mesalamine. Patients were randomized to either receiving 1 g mesalamine enema nightly versus placebo and disease activity was assessed at 4 and 8 weeks. Disease activity was assessed using endoscopic signs of improvement and clinical features of response. Briefly, clinical and endoscopic features of response include decrease stool frequency, decrease episodes of rectal bleeding, physician global assessment, and decreased erythema, friability, and ulcerations on endoscopy. Objective scoring system was established for different stages of the clinical features and accordingly the endpoints of remission and clinical improvement were defined. The combination therapy of oral and enema mesalamine treatment was shown to be superior to oral alone in terms of both remission and improvement. Improvement was obtained in 89% of mesalamine enema group versus 62% of the placebo group at week 4 (p = 0.0008). At week 8, 86% of the mesalamine enema group versus 68% of the placebo group (p = 0.026) showed improvement (Marteau et al 2005) (see Figure 4).

Bottom Line: Newer formulations of salicylates based drugs with fewer side-effects have been developed.In the setting of left-sided distal colitis (proctitis), topical (rectal) formulations have been found to be superior to oral aminosalicylates at inducing remission.Mesalamine has been shown to be safe in short term use with a dose-response efficacy without dose-related toxicity.

View Article: PubMed Central - PubMed

Affiliation: Brigham and Women’s Hospital, Harvard Medical School Boston, MA, USA.

ABSTRACT
Ulcerative colitis (UC) is a chronic inflammatory condition of unclear etiology affecting the large bowel, most commonly the rectum and extending proximally in a continuous fashion. The overall principle in the pathophysiolgy of ulcerative colitis is the dysregulation of the normal immune system against an antigenic trigger leading to a prolonged mucosal inflammatory response. The diagnosing of UC is made by combining the clinical picture, tissue biopsy with the endoscopic appearance of mucosal ulceration, friable, edematous, erythematous granular appearing mucus. The approach to therapy of UC has been dependent on severity of symptoms with frontline therapy being salicylate based sulfasalazine. Newer formulations of salicylates based drugs with fewer side-effects have been developed. These are free of the sulphur component and are composed of 5-ASA, without the sulfapyridine carrier molecule. Mesalamine is one of these 5-ASA based agents that are currently available and indicated for treatment of UC. In mild/moderate active disease mesalamine has response rates between 40%-70% and remission rates of 15%-20%. Considering that the efficacy of 5-ASA is dose dependent, 4.8 g/day and 2.4 g/day have been shown to be the optimal dosages for mild-moderate distal active disease and for maintenance therapy, respectively. Patients with moderately active ulcerative colitis treated with 4.8 g/d of mesalamine are significantly more likely to achieve overall improvement at week 6 compared to patients treated with 2.4 g/d. In the setting of left-sided distal colitis (proctitis), topical (rectal) formulations have been found to be superior to oral aminosalicylates at inducing remission. Mesalamine has been shown to be safe in short term use with a dose-response efficacy without dose-related toxicity.

No MeSH data available.


Related in: MedlinePlus