1
|
Hamdeh S, Micic D, Hanauer S. Drug-Induced Colitis. Clin Gastroenterol Hepatol 2021; 19:1759-1779. [PMID: 32360808 DOI: 10.1016/j.cgh.2020.04.069] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
Drug-induced colitis encompasses a wide spectrum of colon disorders that can manifest microscopically or macroscopically. Patients present with new-onset colitis or exacerbations of inflammatory bowel diseases; in some cases, colitis resolves with discontinuation of medication. Mucosal injury can be focal or extensive, involving the entire colonic mucosa, and sometimes involves other parts of the gastrointestinal tract. It has been a challenge to determine the proportion of new-onset colitis caused by medication and there are few data on the overall prevalence. We review the drugs that have been linked with development of drug-induced colitis and strategies for physicians who believe their patients have this disorder-usually discontinuation of the drug believed to cause colitis and treatment with steroids or immune-modulating therapies. Physicians must be aware of medications that can cause colitis.
Collapse
Affiliation(s)
- Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Kansas City, Kansas.
| | - Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Stephen Hanauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
2
|
Hiraoka S, Fujiwara A, Toyokawa T, Higashi R, Moritou Y, Takagi S, Matsueda K, Suzuki S, Miyaike J, Inokuchi T, Takahara M, Kato J, Okada H. Multicenter survey on mesalamine intolerance in patients with ulcerative colitis. J Gastroenterol Hepatol 2021; 36:137-143. [PMID: 32525567 DOI: 10.1111/jgh.15138] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Although oral mesalamine is the first-choice drug for treating mild-to-moderate ulcerative colitis (UC), some patients show symptoms of intolerance, including exacerbation of diarrhea and abdominal pain. The present study clarified the current state and clinical courses of patients with mesalamine intolerance. METHODS Patients who were diagnosed with UC and administered oral mesalamine at eight hospitals in Japan with a follow-up period exceeding 1 year were analyzed. RESULTS Sixty-seven (11%) of 633 patients showed intolerance to at least one formulation of oral mesalamine. The frequency of mesalamine intolerance has increased in recent years, rising from 5.3% in 2007-2010 to 9.1% in 2011-2013 and 16.2% in 2014-2016. The most common complications were the exacerbation of diarrhea (n = 29), a fever (n = 25), and abdominal pain (n = 22). Readministration of mesalamine/sulfasalazine was attempted in 43 patients, mostly with other types of formulation of mesalamine, and more than half of these patients proved to be tolerant. The risk factors for mesalamine intolerance were female gender (odds ratio [OR] = 1.83; 95% confidence interval [CI], 1.08-3.12), age < 60 years old (OR = 2.82; CI, 1.19-8.33), and pancolitis (OR = 2.09; 95% CI, 1.23-3.60). There were no significant differences in the use of anti-tumor necrosis factor-α agents, colectomy, or steroid-free remission at the last visit between patients with and without mesalamine intolerance. CONCLUSIONS Mesalamine intolerance is not rare, and its frequency has been increasing recently. The prognosis of patients with mesalamine intolerance did not differ significantly from that of those without intolerance.
Collapse
Affiliation(s)
- Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Akiko Fujiwara
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Hiroshima, Japan
| | - Reiji Higashi
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yuki Moritou
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shinjiro Takagi
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Seiyuu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Japan
| | - Jiro Miyaike
- Department of Gastroenterology, Saiseikai Imabari General Hospital, Imabari, Japan
| | - Toshihiro Inokuchi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masahiro Takahara
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| |
Collapse
|
3
|
Lewin S, Velayos FS. Day-by-Day Management of the Inpatient With Moderate to Severe Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2020; 16:449-457. [PMID: 34035752 PMCID: PMC8132655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hospitalization for inflammatory bowel disease is common and requires coordination of care. The goals of hospitalization are to markedly improve symptoms, transition management to an outpatient regimen, and prevent complications. Initially, providers should determine the phenotype and severity of disease flare and provide optimal medical salvage therapy for induction of disease remission. In addition, complications of Crohn's disease and ulcerative colitis should be addressed with testing for Clostridioides difficile and cytomegalovirus infections and pharmacologic venous thromboembolism prophylaxis, and early enteral feeding should be encouraged to optimize nutritional status. A standardized daily assessment to determine response to treatment should be performed. Objective measures of response to disease treatment that are measured within 3 to 4 days of hospitalization can predict which patients will benefit from either second-line rescue therapy or surgical intervention. These same measures can be used to determine readiness for hospital discharge. Safe discharge can be optimized with thorough patient education and a comprehensive outpatient follow-up plan.
Collapse
Affiliation(s)
- Sara Lewin
- Division of Gastroenterology; University of California, San Francisco; San Francisco, California
| | - Fernando S. Velayos
- Department of Gastroenterology and Hepatology, Kaiser Permanente Medical Group, San Francisco, California
| |
Collapse
|
4
|
Ungaro RC, Limketkai BN, Jensen CB, Allin KH, Agrawal M, Ullman T, Colombel JF, Jess T. Stopping 5-aminosalicylates in patients with ulcerative colitis starting biologic therapy does not increase the risk of adverse clinical outcomes: analysis of two nationwide population-based cohorts. Gut 2019; 68:977-984. [PMID: 30420398 PMCID: PMC7057119 DOI: 10.1136/gutjnl-2018-317021] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The benefit of continuing 5-aminosalicylate (5-ASA) in patients with ulcerative colitis (UC) who initiate anti-tumour necrosis factor-alpha (anti-TNF) biologics is unknown. We aimed to compare clinical outcomes in patients with UC already on 5-ASA who started anti-TNF and then either stopped or continued 5-ASA. DESIGN Our primary outcome was any adverse clinical event defined as a composite of new corticosteroid use, UC-related hospitalisation or surgery. We used two national databases: the United States (US) Truven MarketScan health claims database and the Danish health registers. Patients with UC who started anti-TNF after having been on oral 5-ASA for at least 90 days were included. Patients were classified as stopping 5-ASA if therapy was discontinued within 90 days of starting anti-TNF. We performed multivariable Cox regression models controlling for demographics, clinical factors and healthcare utilisation. Adjusted HRs (aHR) with 95% CI are reported comparing stopping 5-ASA with continuing 5-ASA. RESULTS A total of 3589 patients with UC were included (2890 US and 699 Denmark). Stopping 5-ASA after initiating anti-TNF was not associated with an increased risk of adverse clinical events in the U.S. cohort (aHR 1.04; 95% CI 0.90 to 1.21, p=0.57) nor in the Danish cohort (aHR 1.09; 95% CI 0.80 to 1.49, p=0.60). Results were similar in sensitivity analyses investigating concomitant immunomodulator use and duration of 5-ASA treatment before initiating anti-TNF. CONCLUSION In two national databases, stopping 5-ASA in patients with UC starting anti-TNF therapy did not increase the risk of adverse clinical events. These results should be validated in a prospective clinical trial.
Collapse
Affiliation(s)
- Ryan C Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Berkeley N Limketkai
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Camilla Bjørn Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Manasi Agrawal
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas Ullman
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tine Jess
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| |
Collapse
|
5
|
Nishio M, Ishii Y, Hashimoto Y, Otake H, Ogashiwa T, Tsuda S, Yasuhara H, Saigusa Y, Kimura H, Maeda S, Kunisaki R. Short- and long-term efficacy of adalimumab salvage therapy after failure of calcineurin inhibitors in steroid-refractory ulcerative colitis. Scand J Gastroenterol 2019; 53:1236-1244. [PMID: 30353757 DOI: 10.1080/00365521.2018.1511825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Calcineurin inhibitors are highly effective in patients with corticosteroid-refractory ulcerative colitis (UC). When therapy with calcineurin inhibitors fails, adalimumab can be considered to avoid colectomy. The efficacy and safety of this sequential alternative salvage therapy remain unknown. Therefore, the present study was performed to investigate the short- and long-term efficacy and safety of adalimumab after failure of calcineurin inhibitors in corticosteroid-refractory UC. MATERIALS AND METHODS Patients with a corticosteroid-refractory flare of UC who did not respond to calcineurin inhibitors and received continuing salvage therapy with adalimumab were included in this retrospective, observational, single-centre study. The cumulative rates of colectomy were calculated using the Kaplan-Meier method. Clinical remission and response were evaluated based on the Rachmilewitz index. The cumulative rates of colectomy were calculated. Predictive factors for clinical remission and colectomy were identified. In the safety evaluation, any adverse event occurring after the administration of adalimumab was considered. RESULTS Forty-one patients were enrolled; 78% had extensive colitis and 87% had moderate to severe colitis. Seventeen patients (41%) underwent colectomy during the follow-up period. At week 8, 26, and 52 after adalimumab injection, 27%, 39%, and 32% of patients achieved clinical remission, respectively. The adverse event rate was 17%, including one case of tuberculosis. CONCLUSIONS The efficacy of adalimumab for calcineurin inhibitor-refractory UC was examined for the first time. Treatment with adalimumab avoided the need for colectomy in two-thirds of patients with corticosteroid-refractory UC in whom calcineurin inhibitors had failed. However, attention is needed to avoid adverse events, especially infection.
Collapse
Affiliation(s)
- Masafumi Nishio
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan.,b Department of Gastroenterology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yoshito Ishii
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Yu Hashimoto
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Haruka Otake
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Tsuyoshi Ogashiwa
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Saya Tsuda
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Hisae Yasuhara
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Yusuke Saigusa
- c Department of Biostatistics , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Hideaki Kimura
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| | - Shin Maeda
- b Department of Gastroenterology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Reiko Kunisaki
- a Inflammatory Bowel Disease Center , Yokohama City University Medical Center , Yokohama , Japan
| |
Collapse
|
6
|
Tsuboi R, Matsumoto S, Miyatani H, Mashima H. Crohn's Disease with Mesalazine Allergy that Was Difficult to Differentiate from Comorbid Ulcerative Colitis. Intern Med 2019; 58:649-654. [PMID: 30333413 PMCID: PMC6443567 DOI: 10.2169/internalmedicine.1607-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
An 18-year-old man diagnosed with ileocolonic Crohn's disease with circumferential strictures of the ascending colon started treatment with mesalazine and subsequently underwent right hemicolectomy. After surgery, the patient was started on adalimumab, and the clinical course was favorable. Nine months postoperatively, colonoscopy revealed granular mucosa with circumferential and continuous involvement from the transverse colon down to the rectum, findings which resembled ulcerative colitis. Mesalazine allergy was suspected, and the inflammatory findings resolved after discontinuing mesalazine. In patients of inflammatory bowel disease receiving mesalazine with an atypical clinical course, the possibility of mesalazine allergy must be borne in mind.
Collapse
Affiliation(s)
- Rumiko Tsuboi
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| |
Collapse
|
7
|
Miyoshi J, Matsuoka K, Yoshida A, Naganuma M, Hisamatsu T, Yajima T, Inoue N, Okamoto S, Iwao Y, Ogata H, Ueno F, Hibi T, Kanai T. 5-Aminosalicylic acid aggravates colitis mimicking exacerbation of ulcerative colitis. Intest Res 2018; 16:635-640. [PMID: 30301334 PMCID: PMC6223450 DOI: 10.5217/ir.2018.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/23/2018] [Indexed: 11/24/2022] Open
Abstract
Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.
Collapse
Affiliation(s)
- Jun Miyoshi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Yoshida
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoharu Yajima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Nagamu Inoue
- Centers for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Susumu Okamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Iwao
- Centers for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Centers for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Fumiaki Ueno
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Hirono H, Watanabe K, Hasegawa K, Honma T, Ajioka Y, Ohkoshi S. A Case of Right-Sided Ulcerative Colitis with Mesalamine-Induced Hypersensitivity Reactions. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:623-629. [PMID: 29849018 PMCID: PMC6005098 DOI: 10.12659/ajcr.909644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient: Female, 56 Final Diagnosis: Right-sided ulcerative colitis • mesalamine-induced hypersensitivity Symptoms: High fever • vague discomfort of the upper abdomen Medication: Mesalamine Clinical Procedure: — Specialty: Gastroenterology and Hepatology
Collapse
Affiliation(s)
- Haruka Hirono
- Department of Internal Medicine, Nippon Dental University School of Life Dentistry at Niigata, Chuo-ku, Niigata, Japan
| | - Kazuhiko Watanabe
- Department of Internal Medicine, Nippon Dental University School of Life Dentistry at Niigata, Chuo-ku, Niigata, Japan
| | - Katsuhiko Hasegawa
- Department of Internal Medicine, Nippon Dental University School of Life Dentistry at Niigata, Chuo-ku, Niigata, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Teraji, Niigata, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Shogo Ohkoshi
- Department of Internal Medicine, Nippon Dental University School of Life Dentistry at Niigata, Chuo-ku, Niigata, Japan
| |
Collapse
|
9
|
Dorreen A, Heisler C, Jones J. Treatment of Inflammatory Bowel Disease in the Older Patient. Inflamm Bowel Dis 2018; 24:1155-1166. [PMID: 29788361 DOI: 10.1093/ibd/izy023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 12/11/2022]
Abstract
The incidence of inflammatory bowel disease (IBD) is increasing, and as our population ages, there is a growing number of IBD patients who are transitioning into advanced age; 15% to 20% of IBD patients are classified as late-onset (between 60-65 years of age). This has led clinicians to treat a large number of older patients with IBD. The principles of management of IBD in older patients are the same as those who are younger. There are, however, phenotypic differences that are unique to late-onset IBD and age-related concerns that clinicians must consider when initiating therapy for their older patients with IBD. Given the increasing number of older IBD patients, the aim of this article is to present an updated, evidence-based review of the therapeutic options and issues that arise in this unique patient population.
Collapse
Affiliation(s)
- Alastair Dorreen
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Courtney Heisler
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Epidemiology and Biostatistics, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
10
|
Affiliation(s)
- Jun Kato
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeichi Yoshida
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
11
|
Kedia S, Limdi JK, Ahuja V. Management of inflammatory bowel disease in older persons: evolving paradigms. Intest Res 2018; 16:194-208. [PMID: 29743832 PMCID: PMC5934592 DOI: 10.5217/ir.2018.16.2.194] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023] Open
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing, and considering the aging population, this number is set to increase further in the future. The clinical features and natural history of elderly-onset IBD have many similarities with those of IBD in younger patients, but with significant differences including a broader differential diagnosis. The relative lack of data specific to elderly patients with IBD, often stemming from their typical exclusion from clinical trials, has made clinical decision-making somewhat challenging. Treatment decisions in elderly patients with IBD must take into account age-specific concerns such as comorbidities, locomotor and cognitive function, and polypharmacy, to set realistic treatment targets in order to enable personalized treatment and minimize harm. Notwithstanding paucity of clinical data, recent studies have provided valuable insights, which, taken together with information gleaned from previous studies, can broaden our understanding of IBD. These insights may contribute to the development of paradigms for the holistic and, when possible, evidence-based management of this potentially vulnerable population and are the focus of this review.
Collapse
Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Jimmy K Limdi
- Salford & Pennine Clinical Research Unit, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
Shimizu H, Arai K, Tang J, Hosoi K, Funayama R. 5-Aminosalicylate intolerance causing exacerbation in pediatric ulcerative colitis. Pediatr Int 2017; 59:583-587. [PMID: 28063246 DOI: 10.1111/ped.13235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND 5-Aminosalicylate (5-ASA) is widely used as the first-line drug for ulcerative colitis (UC). 5-ASA is mostly a safe and effective drug, but it can bring about exacerbation due to 5-ASA intolerance. 5-ASA intolerance can be confusing and it can mislead physicians into considering unnecessary treatment escalation, including corticosteroid (CS), biologics, or even surgery. In spite of the clinical importance of 5-ASA intolerance, there have been few studies on its incidence, clinical features, and diagnosis. METHODS In order to evaluate the incidence, characteristic symptoms, disease course, and laboratory data of children with 5-ASA intolerance, we retrospectively reviewed the medical records of 80 children with UC. RESULTS Eleven of 80 children (13.8%) with UC were diagnosed with 5-ASA intolerance. The median time between the initiation of 5-ASA and the onset of 5-ASA intolerance was 10 days (range, 4-20 days) in patients not receiving CS. Drug-induced lymphocyte stimulation test (DLST) was performed in 10 patients, and was positive in eight. C-reactive protein (CRP) increased significantly when exacerbation of colitis symptoms occurred. CONCLUSIONS The incidence of 5-ASA intolerance was relatively high. Besides the challenge test, elevation of CRP and positive DLST appeared to support the diagnosis of 5-ASA intolerance.
Collapse
Affiliation(s)
- Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Julian Tang
- Department of Education for Clinical Research, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Kenji Hosoi
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan.,Department of Pediatrics, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
| | - Rie Funayama
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan.,Faculty of Home Economics, Tokyo Kasei University, Itabashi, Tokyo, Japan
| |
Collapse
|
13
|
Affiliation(s)
- Ichiro Otani
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
14
|
Nimmons D, Limdi JK. Elderly patients and inflammatory bowel disease. World J Gastrointest Pharmacol Ther 2016; 7:51-65. [PMID: 26855812 PMCID: PMC4734955 DOI: 10.4292/wjgpt.v7.i1.51] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/13/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; loco-motor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management.
Collapse
|
15
|
Kawai T, Arai K, Harayama S, Nakazawa Y, Goto F, Maekawa T, Tamura E, Uchiyama T, Onodera M. Severe and Rapid Progression in Very Early-Onset Chronic Granulomatous Disease-Associated Colitis. J Clin Immunol 2015; 35:583-8. [DOI: 10.1007/s10875-015-0180-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 12/31/2022]
|
16
|
Hojsak I, Pavić AM, Kolaček S. Mesalamine treatment mimicking relapse in a child with ulcerative colitis. World J Pediatr 2014; 10:371-3. [PMID: 24974209 DOI: 10.1007/s12519-014-0485-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/25/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are reports on mesalamine-induced bloody diarrhea mimicking ulcerative colitis (UC) relapse, mostly in adults. METHODS Herein we present a case of a child with UC who developed relapse of hemorrhagic colitis related to mesalamine. RESULTS A 10-year-old girl developed severe symptoms mimicking UC relapse 3 weeks after introduction of mesalamine therapy. After mesalamine was withdrawn, her symptoms improved, but deteriorated again during the challenge of mesalamine despite concomitant use of corticosteroids. CONCLUSION This is the first case report on such a young child during the concomitant use of corticosteroids.
Collapse
Affiliation(s)
- Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia,
| | | | | |
Collapse
|
17
|
Ha CY. Medical management of inflammatory bowel disease in the elderly: balancing safety and efficacy. Clin Geriatr Med 2014; 30:67-78. [PMID: 24267603 DOI: 10.1016/j.cger.2013.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The medical management of inflammatory bowel disease (IBD) in the older patient extends beyond luminal disease activity. Factors such as comorbidity, functional status, polypharmacy, and age-related changes in physical reserve and drug metabolism may affect therapeutic decision making. The older patient with IBD is more susceptible to disease-related complications and also to adverse events with therapy, particularly immunosuppression. Appropriate medication selection along with multidisciplinary care, factoring not only disease activity but also these age-related risk factors, may improve therapeutic outcomes and decrease adverse events to therapy.
Collapse
Affiliation(s)
- Christina Y Ha
- Division of Digestive Diseases, Center for Inflammatory Bowel Diseases, The David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 365C, Los Angeles CA 90095, USA.
| |
Collapse
|
18
|
Ding H, Liu XC, Mei Q, Xu JM, Hu XY, Hu J. Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity. World J Gastroenterol 2014; 20:3716-3718. [PMID: 24707159 PMCID: PMC3974543 DOI: 10.3748/wjg.v20.i13.3716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/21/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption. However, previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever, rashes, colitis exacerbation and acute eosinophilic pneumonia. Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories. In light of symptom exacerbation of ulcerative colitis, increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration, and the Naranjo algorithm score of 10, the possibility of hypersensitivity reaction to mesalamine suppositories should be considered, warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.
Collapse
|
19
|
Pola S, Patel D, Ramamoorthy S, McLemore E, Fahmy M, Rivera-Nieves J, Chang JT, Evans E, Docherty M, Talamini M, Sandborn WJ. Strategies for the care of adults hospitalized for active ulcerative colitis. Clin Gastroenterol Hepatol 2012; 10:1315-1325.e4. [PMID: 22835577 PMCID: PMC4226798 DOI: 10.1016/j.cgh.2012.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/15/2012] [Accepted: 07/11/2012] [Indexed: 02/07/2023]
Abstract
Ulcerative colitis is a chronic inflammatory disease of the colon; as many as 25% of patients with this disease require hospitalization. The goals of hospitalization are to assess disease severity, exclude infection, administer rapidly acting and highly effective medication regimens, and determine response. During hospitalization, patients should be given venous thromboembolism prophylaxis and monitored for the development of toxic megacolon. Patients who do not respond to intravenous corticosteroids should be considered for rescue therapy with infliximab or cyclosporine. Patients who are refractory to medical therapies or who develop toxic megacolon should be evaluated promptly for colectomy. Patients who do respond to medical therapies should be discharged on an appropriate maintenance regimen when they meet discharge criteria. We review practical evidence-based management principles and propose a day-by-day algorithm for managing patients hospitalized for ulcerative colitis.
Collapse
Affiliation(s)
- Suresh Pola
- Inflammatory Bowel Disease Center, Division of Gastroenterology, University of California San Diego Health System, La Jolla, CA, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Freeman HJ. Medical management of ulcerative colitis with a specific focus on 5-aminosalicylates. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2012; 5:77-83. [PMID: 24833937 PMCID: PMC3987765 DOI: 10.4137/cgast.s8673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Medical management of ulcerative colitis has continued to evolve over more than half of a century. Perhaps, the important advance was the development of sulfasalazine, a drug initially used for the treatment of inflammatory joint disease and only later in the treatment of inflammatory bowel disease. Sulfasalazine was a combination designer drug consisting of sulfapyridine, a sulfa-containing antibacterial agent, and 5-amino-salicylate (5-ASA), an anti-inflammatory agent. Its value appeared to be its ability to target a therapeutic concentration of the 5-ASA component of the medication primarily in the colon, largely avoiding proximal small intestinal absorption. With increasing experience, however, it also became evident that many patients treated with sulfasalazine developed intolerance to the drug and, in some rare instances, serious drug-induced hypersensitivity reactions, largely to the sulfapyridine portion. As a result, a number of alternative forms of delivery of 5-ASA were developed consisting of either a similar sulfasalazine-like prodrug formulation requiring luminal destruction of an azo-bond releasing the 5-ASA or a pH-dependent 5-ASA packaging system that permitted release in the distal intestine, particularly in the colon. As a result, 5-ASA—containing medications continue to provide a valuable management tool for remission induction in mildly to moderately active distal or extensive ulcerative colitis, an additional option for more severely symptomatic disease and value for maintenance therapy with limited potential side effects, even with long-term use.
Collapse
Affiliation(s)
- Hugh James Freeman
- Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
21
|
Shimodate Y, Takanashi K, Waga E, Fujita T, Katsuki S, Nomura M. Exacerbation of bloody diarrhea as a side effect of mesalamine treatment of active ulcerative colitis. Case Rep Gastroenterol 2011; 5:159-65. [PMID: 21552438 PMCID: PMC3088741 DOI: 10.1159/000326931] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mesalamine has been used as the first-line therapy for the treatment of ulcerative colitis (UC) because of its efficacy and fewer side effects. However, earlier study showed that mesalamine occasionally causes diarrhea. We are presenting a patient with active UC in whom bloody diarrhea accompanied by abdominal pain and fever occurred and the symptoms were aggravated after administration of mesalamine. In order to clarify the reason of symptoms aggravation, drug lymphocyte stimulation test and rechallenge trial with mesalamine were performed. The results indicated the possibility that aggravation was related to allergic reaction and was dose-dependent. Furthermore, we examined colonoscopic views but there was no remarkable change in before and after rechallenge trial. Based on the above result, the patient was diagnosed with mesalamine intolerance. In order to differentiate whether the exacerbation of bloody diarrhea is due to the side effects of the mesalamine or a true relapse of UC, taking careful history before and after increasing mesalamine dosage as well as being aware of side effects of mesalamine are required. Clinicians should be aware of diarrhea as a side effect of mesalamine particularly after onset of mesalamine formulation, change in mesalamine formulation, or change in mesalamine dose.
Collapse
Affiliation(s)
- Yuichi Shimodate
- Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Japan
| | | | | | | | | | | |
Collapse
|
22
|
Gupta MK, Pollack S, Hutchings JJ. Mesalamine induced symptom exacerbation of ulcerative colitis: Case report and brief discussion. World J Gastrointest Pharmacol Ther 2010; 1:132-4. [PMID: 21577308 PMCID: PMC3091157 DOI: 10.4292/wjgpt.v1.i6.132] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/02/2010] [Accepted: 10/09/2010] [Indexed: 02/06/2023] Open
Abstract
This paper describes a rare case in which the oral administration of mesalamine resulted in the exacerbation of ulcerative colitis (UC) in a patient who was previously responsive to mesalamine and whose colitis had been in remission for eight years. Mesalamine and other 5-aminosalicylic acid compounds are the mainstay of treatment for UC; however up to 8% of patients are unable to take the medications due to intolerance or hypersensitivity reactions. Common drug reactions are fever, nausea, diarrhea and abdominal pain; however, exacerbation of UC has rarely been reported. This study highlights the importance of ruling out mesalamine as the causative agent in cases of UC exacerbations.
Collapse
Affiliation(s)
- Maneesh Kumar Gupta
- Maneesh Kumar Gupta, Department of Internal Medicine, LSU Health Sciences Center, New Orleans, LA 70112, United States
| | | | | |
Collapse
|
23
|
Katz S, Feldstein R. Inflammatory bowel disease of the elderly: a wake-up call. Gastroenterol Hepatol (N Y) 2008; 4:337-347. [PMID: 21990970 PMCID: PMC3093721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As the baby-boomer generation enters the ranks of the elderly (defined as patients over 60 years of age), the increased burden of managing older inflammatory bowel disease (IBD) patients requires recognition of the impact of comorbid disease, polypharmacy, and surgical candidacy criteria. There is a surprisingly positive response to newer therapies and surgery, provided that a distinction is made between "fit elderly" and "frail elderly" patients. The former group should not be denied access to the newer biologics, clinical trials, or surgical alternatives on the basis of age alone. There is a need for clinicians caring for elderly IBD patients to be cognizant of the multiple and often disguised conditions contributing to disease management as well as the importance for careful allocation of health resources.
Collapse
Affiliation(s)
- Seymour Katz
- Dr. Katz serves as Clinical Professor of Medicine at the New York University School of Medicine in New York, New York, and as an Attending Gastroenterologist at North Shore University Hospital-Long Island Jewish Medical Center in Manhasset, New York
| | | |
Collapse
|
24
|
Abstract
One of the most challenging aspects of the management of inflammatory bowel disease is the high frequency of incomplete or absent response to medical therapy. Although many patients may be truly refractory to medical therapy, a lack of response may indicate several possibilities, including incorrect diagnosis, progression of disease extent, intestinal complication, superinfection, underdosing of therapy, monotherapy instead of combination therapy, or medication intolerance. This article provides a practical general approach to refractory inflammatory bowel disease patients encountered in clinical practice.
Collapse
Affiliation(s)
- Craig A Solem
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 First Street, SW, Rochester, MN 55905, USA
| | | |
Collapse
|
25
|
Greenwald DA, Brandt LJ. Inflammatory Bowel Disease After Age 60. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2003; 6:213-225. [PMID: 12744821 DOI: 10.1007/s11938-003-0003-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
New-onset idiopathic inflammatory bowel disease (IBD) is not uncommon among the elderly, although more common are colonic infection, ischemia, or neoplasia, all of which may mimic IBD. Although the clinical presentation of IBD in the elderly often resembles that of younger subjects, atypical manifestations are common and may lead to difficulty in diagnosis. Much progress has been made in both medical and surgical therapy for IBD, but such therapy poses additional challenges in the elderly, who are more likely to experience adverse effects of medications or complications of surgery. The elderly generally have a favorable outcome to both medical and surgical therapy for IBD. Although concern about possible untoward effects of therapy is warranted, treatment should not be withheld because of fear of complications.
Collapse
Affiliation(s)
- David A. Greenwald
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
| | | |
Collapse
|
26
|
Iofel E, Chawla A, Daum F, Markowitz J. Mesalamine intolerance mimics symptoms of active inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2002; 34:73-6. [PMID: 11753169 DOI: 10.1097/00005176-200201000-00017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Elizaveta Iofel
- Division of Pediatric Gastroenterology and Nutrition, North Shore-Long Island Jewish Health System, New York University School of Medicine, Manhasset, New York, USA.
| | | | | | | |
Collapse
|
27
|
Clemett D, Markham A. Prolonged-release mesalazine: a review of its therapeutic potential in ulcerative colitis and Crohn's disease. Drugs 2000; 59:929-56. [PMID: 10804042 DOI: 10.2165/00003495-200059040-00016] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
UNLABELLED Prolonged-release mesalazine (Pentasa) consists of ethylcellulose-coated microgranules from which mesalazine (known in the US as mesalamine) is released in the small and large intestine in a diffusion-dependent manner. Dose-dependent improvements in clinical and endoscopic parameters have been reported with prolonged-release mesalazine 2 and 4 g/day in clinical trials in patients with mild to moderately active ulcerative colitis. Induction of clinical and endoscopic remission was achieved in more patients receiving a daily dosage of 4 g/day than in those receiving placebo. In patients with ulcerative colitis in remission, prolonged-release mesalazine is effective in reducing the rate of relapse. Higher dosages tend to be more effective, and a 12-month remission rate of 64% has been reported for patients treated with a 4 g daily dosage of this formulation. Comparative data indicate that prolonged-release mesalazine has similar efficacy in maintaining remission to molar equivalent doses of sulfasalazine. Data from a study in patients with mild to moderately active Crohn's disease indicates that higher dosages (4 g/day) of prolonged-release mesalazine are more effective than placebo in reducing disease activity. After 16 weeks' treatment, 64% of patients receiving a 4 g/day dosage experienced clinical improvement and 43% attained remission. In studies of patients in remission of Crohn's disease, the formulation appears to be more effective in preventing relapse in patients with isolated small bowel disease than in those with colonic involvement. The tolerability profile of oral prolonged-release mesalazine is similar to that of placebo and the incidence of adverse events does not appear to be dose-related. Nausea/vomiting, diarrhoea, abdominal pain and dyspepsia occur most frequently, although their incidence is low. Reports of nephrotoxicity during prolonged-release mesalazine treatment are rare. CONCLUSIONS Oral prolonged-release mesalazine is effective for maintenance and induction of remission of mild to moderately active colitis, both in patients with distal disease and in those with pancolitis. The formulation has similar efficacy to that of equimolar concentrations of sulfasalazine. Prolonged-release mesalazine also appears to be effective in the treatment of Crohn's disease, and maintenance therapy is of particular value in patients with isolated small bowel involvement. Evidence suggests that higher dosages (3 to 4 g/day) of prolonged-release mesalazine have additional therapeutic benefits over lower dosages in patients with inflammatory bowel disease without increasing the incidence of adverse events.
Collapse
Affiliation(s)
- D Clemett
- Adis International Limited, Mairangi Bay, Auckland, New Zealand.
| | | |
Collapse
|