Beclomethasone dipropionate (3mg) versus 5-aminosalicylic acid (2g) versus the combination of both (3mg/2g) as retention enemas in active ulcerative proctitis

Mulder, Chris J.; Fockens, Paul; Meijer, Jwr; Heide, H. van der; Wiltink, E. H. H.; Tytgat, G. N. J.

doi:10.1097/00042737-199606000-00010

Cited by 180 publications

(112 citation statements)

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“…23,3,15 However, the combination of rectal steroids and 5-ASAs seems to be beneficial. 21 Unexpectedly, in our cohort only a minority of patients with pancolitis received rectal therapy. Since urgency and high stool frequency are related to a rectal involvement a proportion of these patients may profit of an additional rectal therapy.…”

Section: 32mentioning

confidence: 72%

“…They can be added to a 5-ASA treatment. 21 In patients with proctosigmoiditis 5-ASA therapy has also been shown to be effective at a dosage of 2 g/day. 22 Interestingly it was demonstrated that the combination of rectal and oral 5-ASA increased the efficiency of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…However, an additive therapy of topical 5-ASA and steroid may also be beneficial. 21 In moderate active distal colitis topical 5-ASA therapy in combination with oral 5-ASA therapy has proven to be highly effective (88% response after 6 weeks). 22 A meta-analysis of 33 studies showed that topical 5-ASA is more effective as compared to topical conventional steroids or budesonide.…”

Section: Introductionmentioning

confidence: 99%

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Topical therapy is underused in patients with ulcerative colitis

Seibold

Fournier

Beglinger

et al. 2014

Journal of Crohn's and Colitis

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The availability of new topical preparations for the treatment of left sided ulcerative colitis offers a therapy optimization for many patients. Rectal application of steroids and 5-aminosalicylic acid (5-ASA) is associated with fewer side effects and has a higher therapeutic efficacy in left-sided colitis as compared to a systemic therapy. Therefore, we were interested in the use of topical therapy in patients with ulcerative colitis. The key question was whether topical treatment is more frequently used than oral therapy in patients with proctitis and left sided colitis. Data of 800 patients of the Swiss IBD cohort study were analyzed. Sixteen percent of patients of the cohort had proctitis, 21% proctosigmoiditis and 41% pancolitis. Topical therapy with 5-ASA or corticosteroids was given in 26% of patients with proctitis, a combined systemic and topical treatment was given in 13%, whereas systemic treatment with 5-ASA without topical treatment was given in 29%. Proportion of topical drug use decreased with respect to disease extension from 39% for proctitis to 13.1% for pancolitis (P = 0.001). Patients with severe colitis received a significantly higher dose of topical 5-ASA than patients in remission.

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Section: 32mentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Topical therapy is underused in patients with ulcerative colitis

Seibold

Fournier

Beglinger

et al. 2014

Journal of Crohn's and Colitis

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“…On the contrary, another trial in patients with ulcerative proctitis suggested that a BDP enema was less effective than prednisolone 21-phosphate enema in ulcerative proctitis (Table 2) [ Van der Heide et al 1988]. Finally, three studies compared the efficacy of BDP, mesalamine and a combination of both drugs: one investigated topical mesalamine and a BDP enema [Mulder et al 1996], one investigated oral, controlled-release BDP with mesalamine [Rizzello et al 2002], and another compared topical BDP (36.7%) and topical mesalamine (29.2%) in 217 patients with distal active ulcerative colitis and demonstrated similar clinical remission rates between the two treatments [Gionchetti et al 2005].…”

Section: Efficacy In Ulcerative Colitismentioning

confidence: 99%

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Prantera

Marconi

2013

Therap Adv Gastroenterol

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Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroidbased drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn's disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn's disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.

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“…9 Importantly the combination of topical 5-ASA and topical steroids seems to be superior to a single-agent therapy. 10 The value of 5-ASA in CD therapy is controversial. 11 Despite the controversy and lack of evidence for therapeutic benefit many CD patients undergo 5-ASA treatment during their disease course.…”

mentioning

confidence: 99%

The Use of 5-Aminosalicylic Acid in Children and Adolescents With Inflammatory Bowel Disease

Sokollik

Fournier

Rizzuti

et al. 2018

Journal of Clinical Gastroenterology

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Background: In ulcerative colitis (UC) 5-aminosalicylic acid (5-ASA) is recommended as primary therapy for mild to moderate disease. Topical 5-ASA has been proven especially effective. In Crohn’s disease (CD) the evidence for a beneficial role of 5-ASA is weak. We investigated the use of topical and systemic 5-ASA therapy in children and adolescents with inflammatory bowel disease. Materials and Methods: Data of patients younger than 18 years, registered between April 2008 and December 2015 in the Swiss Inflammatory Bowel Disease Cohort, were analyzed. Results: Three hundred twenty pediatric inflammatory bowel disease patients were included; 189 with CD and 131 with UC. Over one third of UC patients [51 (39%)] received topical 5-ASA therapy and 43 (33%) received combination therapy during their disease course. UC patients with left-sided colitis or proctitis were more likely to receive topical or combination therapy as compared with patients with pancolitis (P<0.001 and <0.001, respectively). An increase in the use of topical 5-ASA therapy in UC patients was noted over time from 5% to 38%. Forty-seven percent of CD patients were treated with oral 5-ASA during their disease course. The usage was stable over time at approximately 15% to 20%. Conclusions: In recent years a very positive trend showing an increase in topical 5-ASA therapy in children and adolescents with UC has been observed. However topical therapy is still used with relative low frequency, especially in patients with a more extensive disease. Conversely, despite weak evidence supporting 5-ASA use in CD patients it has been frequently prescribed. Physicians should continue to encourage their UC patients to use topical therapy.

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Beclomethasone dipropionate (3mg) versus 5-aminosalicylic acid (2g) versus the combination of both (3mg/2g) as retention enemas in active ulcerative proctitis

Cited by 180 publications

References 0 publications

Topical therapy is underused in patients with ulcerative colitis

Topical therapy is underused in patients with ulcerative colitis

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

The Use of 5-Aminosalicylic Acid in Children and Adolescents With Inflammatory Bowel Disease

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