What is the real-life maintenance mesalazine dose in ulcerative colitis?

Abstract

Objective: To describe how mesalazine (MSZ) is used in our practice in ulcerative colitis (UC), at what dose, and the success rate (regarding adherence to therapy).Methods: Observational, transversal study, including all patients with UC and with MSZ maintenance therapy seen from September 2014 to February 2015 at two IBD units in Spain. Treatment adherence was measured by the Morisky-Green scale.Results: We included 203 patients (mean MSZ dose: 2.6 ± 1.0 g/d; median of treatment: 19.5 months [IQR: 8-48]). Doses < 2 g/d were used in 15.3% of cases, 2-2.9 g/d doses in 35.0%, 3-3.9 doses in 29.5%, and ≥ 4 g/d doses in the remaining 20.2%. A single daily dose was preferred in 51.2% of cases, two doses in 33.0% and three doses in 15.8%. A different MSZ brand had been previously used in 36.6% of patients. In 134 cases (66%), the maintenance dose had been increased during a flare-up, and in 49 (36.6% of cases) this higher dose had been kept for maintenance (dose ≥ 4 g/d in 36 patients). During the MSZ therapy, 14 patients (6.9%) suffered mild side effects (21.4% altered liver function tests). Therapy adherence was good in 81.8% of cases.Conclusions: Half of our UC patients take high MSZ doses (≥ 3 g/d) as maintenance therapy, with acceptable safety and good adherence. Half of all patients take a single daily dose, and one third needed a different commercial brand during therapy. Opting for a higher MSZ maintenance dose is a possible strategy for a satisfactory maintenance therapy.

Systematic review: safety of mesalazine in ulcerative colitis

“…This study found that there was no significant reduction in glomerular filtration rate while on either therapy . As it has been noted that nephrotoxicity with regard to mesalazine therapy has been documented to occur within 12 months of initiation of treatment, we recommend monitoring creatinine level at initiation of therapy, at 6 months, and again at 12 months.…”

“…Incidence of erectile dysfunction while on mesalazine therapy has been noted to be 0.5% in one observational study . Furthermore, a retrospective study found that out of eight male patients with inflammatory bowel disease found to be infertile, seven were treated with mesalazine.…”

“…Mesalazine (mesalamine) is a first‐line treatment for many patients with ulcerative colitis. It is thought to have a beneficial anti‐inflammatory action via increased expression of peroxisome proliferator‐activated receptors in gastrointestinal epithelial cells . Furthermore, it acts to inhibit COX enzymes, thus affecting prostaglandins and decreasing inflammation of the colon .…”

The Efficacy and Safety of Mesalamine and Probiotics in Mild‐to‐Moderate Ulcerative Colitis: A Systematic Review and Meta‐Analysis

“…It gives anti-inflammatory effects by increasing expression of peroxisome proliferator-activated receptors in gastrointestinal epithelial cells. Furthermore, it acts to inhibit COX enzymes, thus affecting prostaglandins and decreasing inflammation of the colon [12][13][14][15][16]. Unfortunately, it is difficult to cure UC completely, with 74% of patients experiencing at least one relapse during 5-year observation in a prospective population-based cohort study [17].…”

Intrarectally administered polaprezinc attenuates the development of dextran sodium sulfate‑induced ulcerative colitis in mice

“…Mesalamine (MES) is currently the first-choice drug for UC, as it can be used to both cause and maintain the remission of UC (8)(9)(10). Meta-analyses indicated that the effective rate and remission rate of UC patients treated with MES was better than that in a placebo group (11,12). However, although only a small amount of MES reaches the…”