Controversies with aminosalicylates in inflammatory bowel disease.
Aminosalicylates have been shown to exhibit a wide range of anti-inflammatory and immunomodulatory properties. Since the discovery of sulfasalazine's efficacy in ulcerative colitis and the subsequent development of sulfa-free mesalamine delivery systems, aminosalicylates have evolved to become an integral part of our therapeutic armamentarium and are now first-line therapies for the treatment of mildly to moderately active inflammatory bowel disease and for maintenance of remissions after successful induction therapy. Despite the substantial body of evidence supporting the use of aminosalicylates in ulcerative colitis and Crohn's disease, gaps in our evidence base and controversies surrounding aminosalicylates clinical application have emerged. In this review, issues of dose response and optimization of the treatment regimen in ulcerative colitis, the discrimination between oral mesalamine formulations in left-sided colitis, and their efficacy in active and quiescent Crohn's disease are discussed.
Lim
Wee-Chian
WC
Section of Gastroenterology and Nutrition, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
Hanauer
Stephen B
SB
D000636:Aminosalicylic Acids / Q000378:metabolism / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018890:Chemoprevention; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000517:prevention & control; D003424:Crohn Disease / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D019804:Mesalamine / Q000008:administration & dosage / Q000627:therapeutic use; D012074:Remission Induction; D012460:Sulfasalazine / Q000008:administration & dosage / Q000627:therapeutic use
D000636:Aminosalicylic Acids; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D012460:Sulfasalazine; D019804:Mesalamine; D000069285:Infliximab