Treatment of ulcerative colitis with oral mesalamine: advances in drug formulation, efficacy expectations and dose response, compliance, and chemoprevention.
Sulfasalazine, olsalazine, balsalazide, delayed-release mesalamine, controlled-release mesalamine, mesalamine pellets, and Multi-Matrix System mesalamine are effective first-line therapies for the treatment of mildly to moderately active ulcerative colitis and for subsequent maintenance of remission. For induction therapy it is unclear if there is a dose response above 1.5 g, and for maintenance therapy existing data do not support a dose response above 1.5 g. Sulfasalazine has more frequent side effects than olsalazine, balsalazide, and mesalamine formulations. Once-daily dosing with multi-matrix system mesalamine 1.2 g tablets may lead to optimal compliance. Mesalamine >/= 1.2 g and sulfasalazine >/= 2 g reduce the risk of colorectal cancer in patients with ulcerative colitis. Drug formulations, efficacy expectations and dose response, toxicity expectations, compliance considerations, and chemoprevention considerations are reviewed.
Sandborn
William J
WJ
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
D000284:Administration, Oral; D000636:Aminosalicylic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D018890:Chemoprevention; D002986:Clinical Trials as Topic; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D006801:Humans; D019804:Mesalamine / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D010659:Phenylhydrazines / 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; D003692:Delayed-Action Preparations; D010659:Phenylhydrazines; D012460:Sulfasalazine; D019804:Mesalamine; C038637:balsalazide; C032587:olsalazine