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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 of oral and rectal mesalamine therapy produced earlier and more complete relief of rectal bleeding than oral and rectal therapy alone. Pairwise analysis revealed that combination therapy resulted in significantly fewer days to cessation of rectal bleeding compared with either the mesalamine enema (p = 0.04 generalized Wilcoxon test) or mesalamine tablet group (p = 0.002, generalized Wilcoxon test) alone. Adapted from data: Safdi et al (1997).
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fig5: The combination of oral and rectal mesalamine therapy produced earlier and more complete relief of rectal bleeding than oral and rectal therapy alone. Pairwise analysis revealed that combination therapy resulted in significantly fewer days to cessation of rectal bleeding compared with either the mesalamine enema (p = 0.04 generalized Wilcoxon test) or mesalamine tablet group (p = 0.002, generalized Wilcoxon test) alone. Adapted from data: Safdi et al (1997).

Mentions: There is overwhelming data to support the use of topical formulations of 5-ASA in distal left sided colitis. The question arises whether topical therapy alone is efficacious or if topical therapy combined with oral mesalamine would produce higher response rates. A study to compare the efficacy of mesalamine rectal suspension enema, Rowasa (Solvay Pahramceuticals, Inc., Marietta, GA, USA), alone, oral mesalamine (Asacol) alone, and the combination of enema and tablet in patients with distal UC found that the combination of oral and rectal mesalamine therapy was well tolerated and produced earlier and more complete relief of rectal bleeding than oral or rectal therapy alone (Safdi et al 1997) (see Figure 5). However, it has not been clearly defined whether this is a dose response effect or independently a benefit of topical therapy.


The role of mesalamine in the treatment of ulcerative colitis.

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

The combination of oral and rectal mesalamine therapy produced earlier and more complete relief of rectal bleeding than oral and rectal therapy alone. Pairwise analysis revealed that combination therapy resulted in significantly fewer days to cessation of rectal bleeding compared with either the mesalamine enema (p = 0.04 generalized Wilcoxon test) or mesalamine tablet group (p = 0.002, generalized Wilcoxon test) alone. Adapted from data: Safdi et al (1997).
© Copyright Policy
Related In: Results  -  Collection

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

fig5: The combination of oral and rectal mesalamine therapy produced earlier and more complete relief of rectal bleeding than oral and rectal therapy alone. Pairwise analysis revealed that combination therapy resulted in significantly fewer days to cessation of rectal bleeding compared with either the mesalamine enema (p = 0.04 generalized Wilcoxon test) or mesalamine tablet group (p = 0.002, generalized Wilcoxon test) alone. Adapted from data: Safdi et al (1997).
Mentions: There is overwhelming data to support the use of topical formulations of 5-ASA in distal left sided colitis. The question arises whether topical therapy alone is efficacious or if topical therapy combined with oral mesalamine would produce higher response rates. A study to compare the efficacy of mesalamine rectal suspension enema, Rowasa (Solvay Pahramceuticals, Inc., Marietta, GA, USA), alone, oral mesalamine (Asacol) alone, and the combination of enema and tablet in patients with distal UC found that the combination of oral and rectal mesalamine therapy was well tolerated and produced earlier and more complete relief of rectal bleeding than oral or rectal therapy alone (Safdi et al 1997) (see Figure 5). However, it has not been clearly defined whether this is a dose response effect or independently a benefit of topical therapy.

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