Mild to moderate Ulcerative Colitis: 5-ASA efficacy and dosage
A Cochrane review: Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis
5-ASA vs placebo for induction of remission in Ulcerative Colitis
High dose 5-ASA vs low dose 5-ASA for induction in Ulcerative Colitis
5-ASA was superior to placebo and no more effective than SASP. Considering their relative costs, a clinical advantage to using oral 5ASA in place of SASP appears unlikely. 5-ASA dosed once daily appears to be as efﬁcacious and safe as conventionally dosed 5-ASA. Adherence does not appear to be enhanced by once daily dosing in the clinical trial setting. It is unknown if once daily dosing of 5-ASA improves adherence in a community-based setting. There do not appear to be any differences in efficacy or safety among the various 5-ASA formulations. A daily dosage of 2.4 g appears to be a safe and effective induction therapy for patients with mild to moderately active ulcerative colitis. Patients with moderate disease may benefit from an initial dose of 4.8 g/day.
Combined oral and rectal mesalazine for the treatment of mild-to-moderately active ulcerative colitis: Rapid symptom resolution and improvements in quality of life
Probert et al. JCC 2013
Background and aims: Mesalazine (5-aminosalicylic acid) is the standard first-line therapy for mild-to-moderate ulcerative colitis. In the PINCE study, remission rates were significantly greater with combined oral/enema vs. oral/placebo treatment at 8 weeks (64% vs. 43%, respectively; p=0.030). In this analysis, we explored early response, mucosal healing rates, cessation of rectal bleeding, and quality of life in PINCE.
Methods: Patients with extensive mild-to-moderately active ulcerative colitis received 8weeks of oral mesalazine 4 g/day, plus 4 weeks of daily active (1g mesalazine) or placebo enema. Early response was assessed using the abbreviated ulcerative colitis disease activity index. Mucosal healing was assessed by disease activity index endoscopic mucosal appearance score. Cessation of bleeding (patient diaries), quality of life (EQ-5D), and patient acceptability (questionnaire) were also assessed.
Results: Combined mesalazine oral/enema treatment achieved a significantly higher rate of improvement in abbreviated ulcerative colitis disease activity index (score decrease ≥ 2) within 2 weeks, compared with oral-only treatment (p = 0.032). Bleeding ceased significantly more quickly with combination vs. oral therapy (p = 0.003). More patients showed mucosal healing (disease activity index endoscopic mucosal appearance score 0/1) with combination vs. oral therapy, which was significantly different between groups at week 4 (p = 0.052). Both groups showed quality of life improvements, with a significant benefit for combination vs. oral therapy at week 4 in multiple domains. Most patients reported finding the treatment acceptable.
Conclusions: Rapid cessation of symptoms was seen with combination therapy, which is particularly important to patients and may improve quality of life
Feagan, B. G., & MacDonald, J. K. (2012). Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd000543.pub3
Ford, A. C., Achkar, J.-P., Khan, K. J., Kane, S. V., Talley, N. J., Marshall, J. K., & Moayyedi, P. (2011). Efficacy of 5-Aminosalicylates in Ulcerative Colitis: Systematic Review and Meta-Analysis. The American Journal of Gastroenterology, 106(4), 601–616. doi:10.1038/ajg.2011.67
Probert, C. S. J., Dignass, A. U., Lindgren, S., Oudkerk Pool, M., & Marteau, P. (2014). Combined oral and rectal mesalazine for the treatment of mild-to-moderately active ulcerative colitis: Rapid symptom resolution and improvements in quality of life. Journal of Crohn’s and Colitis, 8(3), 200–207. doi:10.1016/j.crohns.2013.08.007