Once‐daily versus multiple‐daily mesalamine for patients with ulcerative colitis: A meta‐analysis

Abstract

OBJECTIVE:To systematically review the efficacy and safety of once-daily (OD) mesalamine for the treatment of ulcerative colitis (UC) compared with multiple-daily (MD) mesalamine. METHODS:Electronic databases up to July 2011 were searched for related studies evaluating the efficacy of OD vs MD for treatment of UC. Only randomized controlled trials (RCTs) were considered eligible. Remission rates or relapse rates were analyzed using intention-to-treat (ITT) and per-protocol (PP) analysis. Pooled relative risk (RR) and 95% confidence interval (CI) were calculated. Publication bias was assessed with a funnel plot. RESULTS:Overall 10 RCTs including 9 full-text manuscripts and one abstract met the inclusion criteria. OD dosing of mesalamine was shown to be as effective as MD dosing for the maintenance of clinical remission in patients with quiescent UC (RR = 1.00, 95% CI 0.89-1.12) by ITT analysis. For active UC, a mild but significant benefit was achieved by OD dosing compared with MD dosing (RR = 0.80, 95% CI 0.64-0.99). Total adverse events were similar using OD and MD mesalamine in quiescent UC (RR = 1.06, 95% CI 0.93-1.20). Compliance with OD was slightly better than with MD (RR = 0.92, 95% CI 0.82-1.03). CONCLUSIONS:OD mesalamine is as effective and has a comparable safety profile as MD regimens for the maintenance treatment of UC, and is even more effective for inducing remission in active UC.

Systematic review: safety of mesalazine in ulcerative colitis

“…A similar study with once daily and three times daily dosing of mesalazine also showed no difference in incidence of adverse events . Several other studies have similarly demonstrated no difference in adverse events between once daily compared to divided dosing for mesalazine …”

Recent developments in the treatment of inflammatory bowel disease

“…However, slow release of the active ingredient constitutes a more elegant and patient‐friendly option. It has also been shown that split dosing of oral 5‐ASA can be replaced by once daily administration …”

“…It has also been shown that split dosing of oral 5-ASA can be replaced by once daily administration. 11 A new MMX delivery system of 1.2 g of MMX mesalazine was tested in a preliminary trial in UC and showed similar rates of remission induction to the combination of mesalazine enema and oral placebo in patients with left-sided colitis. 12 In two pivotal trials with MMX mesalazine at higher doses 13,14 patients with active UC were randomized to receive 2.4 g or 4.8 g of MMX mesalazine once daily versus placebo or 800 mg of slow-release mesalazine.…”

Once daily vs multiple daily mesalamine therapy for mild to moderate ulcerative colitis: a meta‐analysis

“…Several previous systematic reviews and meta‐analyses have compared OD with MD dosing of oral mesalamine . To our knowledge, however, no previous meta‐analysis has studied the administration of mesalamine suppositories and the present study is the first to include trials comparing OD with MD suppositories.…”

“…Zhu et al [30] showed that OD dosing can achieve higher remission rates not only for inducing but also for maintaining remission. Tong et al [32] stated that OD mesalamine can achieve a better efficacy than MD dosing in inducing remission than in maintaining remission (RR 0.80, 95% CI 0.64-0.99). As is well known several factors [34] influence drug efficacy including total doses, formulation of the drug, different routes of administration, disease course and duration of therapy.…”