Olsalazine or sulphasalazine in first attacks of ulcerative colitis? A double blind study.

Abstract

SUMMARY Olsalazine (2 g/day) and sulphasalazine (3 g/day) were compared in a double blind three centre trial in 37 patients presenting with first attack of distal colitis. Sigmoidoscopic appearances, rectal biopsies, and symptom and stool diary records were used to assess benefit and adverse effects. Both groups showed a similar decrease in stool frequency (p<0001). The proportion of unformed stools was also decreased, but to a lesser extent (p<005) in those taking olsalazine (78% v 55%; p<O-OOl) compared with those taking sulphasalazine (72% v 28%; p<0001). There was a diminution in the proportion of stools containing blood in both groups (olsalazine: 61% v 22%; p<0001/sulphasalazine: 67% v 37%; p<0O001). Sigmoidoscopic and histological appearances and clinical activity improved significantly and to a similar extent in both groups. Intolerance was encountered in two patients on olsalazine and four on sulphasalazine; intolerance to sulphasalazine being even higher (five of seven patients) in a preliminary study using a dose of sulphasalazine releasing the same amount of 5-aminosalicylic acid as 2 g olsalazine. Olsalazine was at least as effective as sulphasalazine in the treatment of new patients with distal colitis, and in a dose releasing an equivalent amount of 5-aminosalicylic acid was better tolerated.5-aminosalicylic acid has been shown to be the active therapeutic principle of sulphasalazine, 1-3 and is useful in the treatment of ulcerative colitis.'4 Its exact mechanism of action is not known but it may act by blocking prostaglandin synthesis in the mucosa -7 and/or as an anti-oxidant by suppressing oxidative metabolism of polymorphonuclear leucocytes.' Olsalazine consists of two molecules of 5-ASA linked together by an azo bond.9"' After oral ingestion, most of the drug reaches the colon where it is split by colonic bacteria to release 5-ASA.9" Approximately 80% of patients intolerant of sulphasalazine can tolerate olsalazine." "In controlled trials of patients, a majority of whom were withdrawn from sulphasalazine, olsalazine has been shown to be superior to placebo in the treatment of

A Meta-Analysis of the Efficacy of Sulfasalazine in Comparison with 5-Aminosalicylates in the Induction of Improvement and Maintenance of Remission in Patients with Ulcerative Colitis

“…Thus, 20 trials were included in the analysis (Fig. 1) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Of these 20 studies, 19 obtained acceptable Jadad score of 3 or more [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] ( Table 1).…”

“…The summary RR for overall improvement in three trials that compared SSZ and olsalazine [32,34,40] Fig. 7).…”

A 66-Year-Old Woman With Ulcerative Colitis

“…11 Sulfasalazine, mesalamine, and olsalazine have been proven to be effective in active ulcerative colitis. [12][13][14] These agents often require up to 6 weeks to exert their maximal benefit. As with topical therapy, a full response includes cessation of all symptoms and signs (including bleeding) and a return to a normal appearance of the colonic mucosa on sigmoidoscopy.…”

Treatment of Ulcerative Colitis in the Elderly: A Systematic Review

“…68,83,105,126,131 When compared to sulphasalzine, all 3 studies showed non-inferiority of olsalazine. 66,117,130 There was one study that compared olsalazine 3 g/d to Eudragit-L mesalazine 3 g/d and found similar rates of endoscopic remission. 94 There was one last study that looked at dose response of olsalazine, with findings favoring the higher dose (3 g/d) versus 0.75 g/d and 1.5 g/d.…”