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Yang XY, Yu YF, Tong KK, Hu G, Yu R, Su LJ. Efficacy and safety of Xileisan combined with mesalazine for ulcerative colitis: A meta-analysis and trial sequential analysis. World J Clin Cases 2024; 12:4703-4716. [DOI: 10.12998/wjcc.v12.i21.4703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The benefits and risks of Xileisan (XLS) in the treatment of ulcerative colitis (UC) remain unclear.
AIM The present study aimed to evaluate the efficacy and safety of the combination of XLS and mesalazine when treating UC.
METHODS We searched eight databases for clinical trials evaluating the combination of XLS and mesalazine in the treatment of UC, up to January 2024. Meta-analysis and trial sequential analysis (TSA) were performed using Revman 5.3 and TSA 0.9.5.10 beta, respectively.
RESULTS The present study included 13 clinical studies involving 990 patients, of which 501 patients received XLS combined with mesalazine while 489 patients received mesalazine alone. The meta-analysis showed that, in terms of efficacy, the combination of XLS and mesalazine significantly improved the clinical efficacy rate by 22% [risk ratio (RR) = 1.22; 95%CI: 1.15–1.28; P < 0.00001] and mucosal improvement rate by 25% (RR = 1.25; 95%CI: 1.12–1.39; P = 0.0001), while significantly reducing the duration of abdominal pain by 2.25 days [mean difference (MD) = -2.25; 95%CI: -3.35 to -1.14; P < 0.0001], diarrhea by 2.06 days (MD = -2.06; 95%CI: -3.92 to -0.20; P = 0.03), hematochezia by 2.32 days (MD = -2.32; 95%CI: -4.02 to -0.62; P = 0.008), tumor necrosis factor alpha by 16.25 ng/mL (MD = -16.25; 95%CI: -20.48 to -12.01; P < 0.00001), and interleukin-6 by 14.14 ng/mL (MD = -14.14; 95%CI: -24.89 to -3.39; P = 0.01). The TSA indicated conclusiveness in the meta-analysis of the efficacy endpoints. In terms of safety, the meta-analysis revealed that the combination of XLS and mesalazine did not increase the occurrence of total and gastrointestinal adverse events, abdominal distension, and erythema (P > 0.05). The TSA showed non conclusive findings in the meta-analysis of the safety endpoints. Harbord’s test showed no publication bias (P = 0.734).
CONCLUSION Treatment with XLS alleviated the clinical symptoms, intestinal mucosal injury, and inflammatory response in patients with UC, while demonstrating good safety.
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Affiliation(s)
- Xin-Yu Yang
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Yun-Feng Yu
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Ke-Ke Tong
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Gang Hu
- The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Rong Yu
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Lian-Jun Su
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
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Shin Y, Kim J, Song Y, Kim S, Kong H. Efficacy of Laurus nobilis L. for Tight Junction Protein Imbalance in Leaky Gut Syndrome. Nutrients 2024; 16:1250. [PMID: 38732497 PMCID: PMC11085348 DOI: 10.3390/nu16091250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Laurus nobilis L. (LNL) belongs to the evergreen Lauraceae family. It is native to the Mediterranean and widely distributed in the southern United States, Europe, and the Middle East. LNL is rich in active ingredients of the sesquiterpene lactone series and has been reported to have antioxidant, anti-inflammatory, and anticancer effects. And parthenolide, known as a sesquiterpene lactone-based compound, inhibits the activation of lipopolysaccharide-binding protein (LBP), which is a major trigger for leaky gut syndrome. However, the effectiveness of LNL in improving the state of increased intestinal permeability has not yet been reported. Therefore, we demonstrated the efficacy of LNL, which is known to be rich in parthenolide, in improving intestinal permeability induced by IL-13. We investigated the improvement in permeability and analyzed major tight junction proteins (TJs), permeability-related mechanisms, weight and disease activity indices, and corresponding cytokine mechanisms. LNL maintained TJs homeostasis and clinical improvement by reducing increased claudin-2 through the inhibition of IL-13/STAT6 activation in TJ-damaged conditions. These results are expected to be effective in preventing leaky gut syndrome through the TJ balance and to further improve intestinal-related diseases, such as inflammatory bowel disease.
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Affiliation(s)
- Yelim Shin
- College of Pharmacy, Sahmyook University, Seoul 01795, Republic of Korea; (Y.S.); (J.K.); (Y.S.); (S.K.)
| | - Jiyeon Kim
- College of Pharmacy, Sahmyook University, Seoul 01795, Republic of Korea; (Y.S.); (J.K.); (Y.S.); (S.K.)
- KOSA BIO Inc., 272, Namyangju-si 12106, Republic of Korea
| | - Youngcheon Song
- College of Pharmacy, Sahmyook University, Seoul 01795, Republic of Korea; (Y.S.); (J.K.); (Y.S.); (S.K.)
- PADAM Natural Material Research Institute, Sahmyook University, Seoul 01795, Republic of Korea
| | - Sangbum Kim
- College of Pharmacy, Sahmyook University, Seoul 01795, Republic of Korea; (Y.S.); (J.K.); (Y.S.); (S.K.)
| | - Hyunseok Kong
- PADAM Natural Material Research Institute, Sahmyook University, Seoul 01795, Republic of Korea
- College of Animal Resources Science, Seoul 01795, Republic of Korea
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Akbari AA, Zarghampour A, Hashemzadeh N, Hemmati S, Rahimpour E, Jouyban A. Solubility and thermodynamics of mesalazine in aqueous mixtures of poly ethylene glycol 200/600 at 293.2-313.2K. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00045-2. [PMID: 38579928 DOI: 10.1016/j.pharma.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
In this study, the solubility of mesalazine was investigated in binary solvent mixtures of poly ethylene glycols 200/600 and water at temperatures ranging from 293.2K to 313.2K. The solubility of mesalazine was determined using a shake-flask method, and its concentrations were measured using a UV-Vis spectrophotometer. The obtained solubility data were analyzed using mathematical models including the van't Hoff, Jouyban-Acree, Jouyban-Acree-van't Hoff, mixture response surface, and modified Wilson models. The experimental data obtained for mesalazine dissolution encompassed various thermodynamic properties, including ΔG°, ΔH°, ΔS°, and TΔS°. These properties offer valuable insights into the energetic aspects of the dissolution process and were calculated based on the van't Hoff equation.
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Affiliation(s)
- Anali Ali Akbari
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aynaz Zarghampour
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nastaran Hashemzadeh
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Salar Hemmati
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elaheh Rahimpour
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, 5165665811 Tabriz, Iran.
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Faculty of Pharmacy, Near East University, Po Box: 99138, North Cyprus, Mersin 10, Nicosia, Turkey
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Słoka J, Madej M, Strzalka-Mrozik B. Molecular Mechanisms of the Antitumor Effects of Mesalazine and Its Preventive Potential in Colorectal Cancer. Molecules 2023; 28:5081. [PMID: 37446747 DOI: 10.3390/molecules28135081] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Chemoprevention is one of the ways to fight colorectal cancer, which is a huge challenge in oncology. Numerous pieces of evidence indicate that chronic inflammation in the course of Crohn's disease or ulcerative colitis (UC) is a significant cancer risk factor. Epidemiologic studies suggest that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), including mesalazine, has beneficial effects on colitis-associated colorectal cancer. Mesalazine is a first-line therapy for UC and is also widely used for maintaining remission in UC. Data showed that mesalazine has antiproliferative properties associated with cyclooxygenase (COX) inhibition but can also act through COX-independent pathways. This review summarizes knowledge about mesalazine's molecular mechanisms of action and chemopreventive effect by which it could interfere with colorectal cancer cell proliferation and survival.
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Affiliation(s)
- Joanna Słoka
- Department of Molecular Biology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055 Katowice, Poland
| | - Marcel Madej
- Department of Molecular Biology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055 Katowice, Poland
| | - Barbara Strzalka-Mrozik
- Department of Molecular Biology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055 Katowice, Poland
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Fu W, Xie L, Yu J, He Y, Zeng J, Liu J, Liang K, Chen P, Jiang L, Gu Z, Kong B. In Situ Interfacial Super-Assembly of Nanobiohybrids through Plant for Food-Grade Oral Medicine. ACS APPLIED MATERIALS & INTERFACES 2023; 15:7282-7293. [PMID: 36701261 DOI: 10.1021/acsami.2c19791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Developing a next-generation oral drug delivery system with enhanced efficacy and limited side effects is highly desired for refractory diseases treatment such as colitis. The bioinspired assembly of drugs within food-grade plants highlights its potential value of this unique hybrid material. Herein, we report the preparation of drug-encapsulated vegetable nanobiohybrid superassembled frameworks as an oral food-grade drug delivery system (SAF-FGDD). The in situ superassembly of SAF-FGDD driven by natural transpiration from living plants is carried out through a sustainable and low-carbon manner, allowing for the assembly of distinct precursors inside edible living plants. As an example, mesalazine, an anti-inflammatory drug, is encapsulated in the frameworks for colitis treatment. The cell activity and feeding experiments of zebrafish and mice demonstrate the excellent efficacy of this SAF-FGDD. Compared with those of the control groups, the disease activity index scores and histological scores of the SAF-FGDD group were significantly decreased by 80% and 98%, respectively. The improved performance is attributed to the biocompatibility and protective effect of SAF-FGDD, allowing for abundant mesalazine to be released and act at the site of the intestine during the process of food digestion. In combination with mature soilless cultivation technology, plant-based organisms with natural structure-forming abilities possess broad commercial prospects in large-scale production of various food-grade functional materials.
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Affiliation(s)
- Wenlong Fu
- Department of Chemistry, Shanghai Key Lab of Molecular Catalysis and Innovative Materials, Collaborative Innovation Center of Chemistry for Energy Materials, Fudan University, Shanghai 200438, P. R. China
| | - Lei Xie
- Department of Chemistry, Shanghai Key Lab of Molecular Catalysis and Innovative Materials, Collaborative Innovation Center of Chemistry for Energy Materials, Fudan University, Shanghai 200438, P. R. China
- School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - Jicheng Yu
- Zhejiang Provincial Key Laboratory of Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, P. R. China
| | - Yanjun He
- Department of Chemistry, Shanghai Key Lab of Molecular Catalysis and Innovative Materials, Collaborative Innovation Center of Chemistry for Energy Materials, Fudan University, Shanghai 200438, P. R. China
| | - Jie Zeng
- Department of Chemistry, Shanghai Key Lab of Molecular Catalysis and Innovative Materials, Collaborative Innovation Center of Chemistry for Energy Materials, Fudan University, Shanghai 200438, P. R. China
| | - Jian Liu
- State Key Laboratory of Catalysis, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, P. R. China
| | - Kang Liang
- School of Chemical Engineering, Graduate School of Biomedical Engineering, and Australian Centre for NanoMedicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Pu Chen
- Department of Chemical Engineering, University of Waterloo, Ontario N2L 3G1, Canada
| | - Lei Jiang
- CAS Key Laboratory of Bio-Inspired Materials and Interfacial Science, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
| | - Zhen Gu
- Zhejiang Provincial Key Laboratory of Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, P. R. China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, P. R. China
- Zhejiang Laboratory of Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 311121, P. R. China
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, P. R. China
| | - Biao Kong
- Department of Chemistry, Shanghai Key Lab of Molecular Catalysis and Innovative Materials, Collaborative Innovation Center of Chemistry for Energy Materials, Fudan University, Shanghai 200438, P. R. China
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang 322000, P. R. China
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Saha S, Naik J, Amaresan N, Pithawala M. In silico analysis of Typha domingensis Pers. phytocompounds against wound healing biomarkers and ascertaining through in vitro cell migration assay. 3 Biotech 2022; 12:166. [PMID: 35845110 PMCID: PMC9276916 DOI: 10.1007/s13205-022-03229-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/17/2022] [Indexed: 12/19/2022] Open
Abstract
Typha domingensis Pers. is known for its medicinal properties. Although traditionally T. domingensis Pers. has been used for wound healing, yet scientific investigations reporting its ability to heal wounds are lacking. Phytochemical profiling of T. domingensis Pers. inflorescence crude extract was carried out by LC-MS analysis. Ten phytochemicals were selected for in silico analysis based on retention time, mass-to-charge ratio and resolution of mass spectrum. Molecular docking of all ten compounds was done against selected wound healing biomarkers viz., interleukin 6(IL-6), interleukin β (IL-β), insulin-like growth factor tyrosine kinase receptor (IGF-1R) and transformation growth factor β (TGF-β). Based on this, catechin, mesalazine and piperazine were subjected for in vitro cell migration assay (3T3 L1 mouse fibroblast cell line) to assess their wound healing potentials. Molecular docking revealed that mesalazine, catechin, and piperazine have potential ligands based on lowest docking energy (ranging from - 4.1587 to - 0.972), Glide E score (ranging from - 26.929 to - 57.882), Glide G score (ranging from - 4.16 to - 7.972) and numbers of hydrogen bonds compared to other compounds studied. The migration assay revealed that, compared to control (52.5%), T. domingensis Pers. inflorescence crude extract showed maximum wound healing potential (80%) followed by Catechin (66.8%) Mesalazine (58.3%) and Piperazine (51.2%). The combined in silico and in vitro approach opens new dimension for designing innovative therapeutics to manage different types of wounds.
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Fehily SR, Al-Ani AH, Abdelmalak J, Rentch C, Zhang E, Denholm JT, Johnson D, Ng SC, Sharma V, Rubin DT, Gibson PR, Christensen B. Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management. Aliment Pharmacol Ther 2022; 56:6-27. [PMID: 35596242 PMCID: PMC9325436 DOI: 10.1111/apt.16952] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence. AIM To review the screening, diagnostic practices and medical management of LTBI in patients with IBD. METHODS Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD. RESULTS Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD. CONCLUSIONS Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.
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Affiliation(s)
- Sasha R Fehily
- Gastroenterology Department, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Aysha H Al-Ani
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jonathan Abdelmalak
- Gastroenterology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Clarissa Rentch
- Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Eva Zhang
- Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Justin T Denholm
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Victorian Tuberculosis Program, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute, Parkville, Victoria, Australia
| | - Douglas Johnson
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Britt Christensen
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Gastroenterology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Shergill S. Mesalazine-induced myopericarditis: a case report. Eur Heart J Case Rep 2021; 5:ytaa508. [PMID: 33738396 PMCID: PMC7954390 DOI: 10.1093/ehjcr/ytaa508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/17/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022]
Abstract
Background Mesalazine is a well-established 1st line treatment for inflammatory bowel disease (IBD). Cardiotoxicity following 5-aminosalicyclic-acid therapy remains a rare yet serious complication and can often be challenging to distinguish from myocarditis presenting as an extra-intestinal manifestation of IBD. Case summary We present a case of a 22-year-old man with a background of ulcerative colitis commenced on a mesalazine preparation for disease progression. He presented to our hospital 12 days following drug initiation with acute chest pain, peak troponin-T of 242 ng/L, dynamic electrocardiogram changes, and severe left ventricular systolic dysfunction on transthoracic echocardiogram. The clinical diagnosis of myopericarditis was suspected and mesalazine was stopped shortly after. Outpatient cardiac magnetic resonance performed 2 weeks following mesalazine cessation demonstrated a recovery of cardiac function with associated symptom and biochemical resolution. Discussion Clinicians should be aware of this potentially fatal adverse effect of a commonly prescribed medication. Symptoms of myocarditis often occur within the early stages of mesalazine initiation, which aids the clinical diagnosis. The mainstay of treatment is to simply discontinue the drug with rapid resolution of symptoms seen without any permanent or long-term cardiac dysfunction. Close liaison with the gastroenterology team is key, as 2nd line IBD therapies are often required for the ongoing management of the patient’s colitis.
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Affiliation(s)
- Simran Shergill
- Cardiology Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, UK
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Abstract
Inflammatory bowel disease is a chronic disorder of intestinal inflammation and includes Crohn's disease and ulcerative colitis. The goal of therapy is to induce and maintain remission, which is achieved with conventional therapies. Mesalamine is considered a first-line therapy for ulcerative colitis. Clinical trials have confirmed its efficacy and safety in patients with mild to moderate ulcerative colitis. Doses of more than 2.4 g/d achieve significantly higher rates of clinical and endoscopic remission, with a decreased risk of relapse. Serious adverse effects are rare, but nonadherence is common. Mesalamine is considered safe in pregnancy, excluding formulations with dibutyl phthalate.
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10
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Fehily SR, Martin FC, Kamm MA. Simple water-based tacrolimus enemas for refractory proctitis. JGH OPEN 2019; 4:561-564. [PMID: 32782938 PMCID: PMC7411644 DOI: 10.1002/jgh3.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/31/2019] [Indexed: 01/21/2023]
Abstract
Background and Aims Rectal ulcerative colitis (UC) and Crohn's disease (CD) often do not respond to conventional therapies. Oral and suppository tacrolimus are effective but often poorly tolerated or are complex to formulate. Tacrolimus is topically active, water soluble, and has minimal systemic toxicity when administered rectally; we therefore tested a simple tap water‐based enema formulation. Methods Tacrolimus powder from 1 mg capsules and tap water in a 60 mL syringe were delivered rectally. The primary end‐point was endoscopic response (UC: MAYO score reduction by one point; CD: improvement in ulcer number and severity). Secondary end‐points included endoscopic remission, clinical response, stool frequency, and rectal bleeding. Results Seventeen patients [12 UC, five CD, nine female, median age 31 years] with refractory rectal disease were treated. The majority of patients had failed immunosuppressive therapy [88% thiopurine; 71% biologic therapy]. Initial enemas included 1–4 mg tacrolimus daily and 1–3 mg tacrolimus maintenance three times a week for a median of 20 weeks (range 3–204). Concomitant thiopurine or biologic therapy continued. 94% tolerated therapy. Of 12 UC patients, eight (67%) achieved endoscopic remission, one further patient achieved endoscopic response, and median partial MAYO scores decreased (pre:4 vs. post:2; P = 0.010). Of five CD patients, three (60%) achieved endoscopic response, two (40%) endoscopic remission, and three (60%) clinical response. Stool frequency, rectal bleeding, and C‐reactive protein levels improved. Strictures became endoscopically passable in all four affected patients. No major adverse events were reported, and four patients had disease flare. Conclusions Tacrolimus enemas are easy to prepare, well tolerated, effective, and safe. They should be included in the treatment armamentarium for inflammatory bowel disease‐related refractory proctitis.
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Affiliation(s)
- Sasha R. Fehily
- Department of GastroenterologySt Vincent's HospitalMelbourneVictoriaAustralia
| | - Felicity C. Martin
- Department of GastroenterologySt Vincent's HospitalMelbourneVictoriaAustralia
| | - Michael A. Kamm
- Department of GastroenterologySt Vincent's HospitalMelbourneVictoriaAustralia
- University of MelbourneMelbourneVictoriaAustralia
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11
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Fehily SR, Partsanis NM, Christensen B. Cough in the Immunosuppressed Patient. Gastroenterology 2019; 156:e3-e4. [PMID: 30268786 DOI: 10.1053/j.gastro.2018.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Sasha R Fehily
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Nik M Partsanis
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Britt Christensen
- Departmetn of Gastroenterology, Royal Melbourne Hospital, Fitzroy, Victoria, Australia
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12
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Ahmad H, Kumar VL. Pharmacotherapy of ulcerative colitis - current status and emerging trends. J Basic Clin Physiol Pharmacol 2019; 29:581-592. [PMID: 30089097 DOI: 10.1515/jbcpp-2016-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/04/2018] [Indexed: 12/23/2022]
Abstract
Ulcerative colitis (UC) is a chronic mucosal inflammation of the large intestine restricted to the rectum and colon. Its clinical course follows an intermittent pattern with episodes of relapse, followed by remission and eventually resulting in mucosal damage. Although there is no permanent cure for UC, the currently available pharmacotherapy aims to induce and maintain clinical remission, promote the healing of colonic mucosa and avert any surgical intervention. The conventional drug therapy comprising of 5-aminosalicylates, thiopurines and corticosteroids has advanced recently in terms of formulations and dosing schedule, resulting in improved efficacy, safety and compliance. Calcineurin inhibitors, such as cyclosporin and tacrolimus, have emerged as steroid sparing agents. The treatment paradigm of UC patients who are refractory to conventional drugs has changed in view of the availability of biologics. Currently, there are four biologics approved by the US FDA for the treatment of UC, namely, infliximab, adalimumab, golimumab and vedolizumab, and several others are undergoing clinical trial. In this comprehensive review, the advantages and limitations of the medical therapy of UC are elaborated with an emphasis on the pharmacokinetic and pharmacodynamic aspects of the drugs.
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Affiliation(s)
- Hilal Ahmad
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vijay L Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Sanapalli BKR, Kannan E, Balasubramanian S, Natarajan J, Baruah UK, Karri VVSR. Pluronic lecithin organogel of 5-aminosalicylic acid for wound healing. Drug Dev Ind Pharm 2018; 44:1650-1658. [PMID: 29848103 DOI: 10.1080/03639045.2018.1483393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
5-Aminosalicylic acid (5-ASA) is an aminosalicylate anti-inflammatory drug, which is also known as mesalazine or mesalamine. Currently employed in treating inflammatory bowel disease, ulcerative colitis, inflamed anus or rectum, and maintain remission in Crohn's disease. Evidence from the researchers highlighted its significant re-epithelization in allergic asthma, aphthous, and gastric ulcerative conditions. The objective of the study was to formulate the pluronic lecithin organogel (PLO) containing 5-ASA and evaluate its wound-healing ability in a full thickness excision wound rat model. The data obtained from in silico docking studies revealed 5-ASA is having an affinity towards the transforming growth factor-beta (TGF-β) specifically towards beta1. Among various formulations prepared (F1 to F8), F1, and F6 have shown a maximum in vitro drug release with optimum pH and viscosity. From MTT assay it was found that selected PLO formulations showed no toxicity and enhanced cell proliferation in HaCaT cell lines. In vivo wound-healing studies in albino Wistar rats has revealed that PLO accelerates wound closure and reepithelization to the statistically significant level on day 3 (p < .05) in comparison with untreated wounds. In conclusion, the overall results suggest that 5-ASA PLO gel is a potential therapeutic option for the treatments of wounds, however, further studies are highly warrened to determine the various mechanisms of 5-ASA in regulating the cell migration and reepithelization in wound healing to outspread its use in clinics.
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Affiliation(s)
- Bharat Kumar Reddy Sanapalli
- a Department of Pharmacology , JSS College of Pharmacy, Ootacamund, JSS Academy of Higher Education & Research , Mysuru , India
| | - Elango Kannan
- a Department of Pharmacology , JSS College of Pharmacy, Ootacamund, JSS Academy of Higher Education & Research , Mysuru , India
| | | | - Jawahar Natarajan
- b Department of Pharmaceutics , JSS College of Pharmacy, Ootacamund, JSS Academy of Higher Education & Research , Mysuru , India
| | - Uday Krishna Baruah
- b Department of Pharmaceutics , JSS College of Pharmacy, Ootacamund, JSS Academy of Higher Education & Research , Mysuru , India
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Karkossa F, Klein S. A Biopredictive In Vitro Comparison of Oral Locally Acting Mesalazine Formulations by a Novel Dissolution Model for Assessing Intraluminal Drug Release in Individual Subjects. J Pharm Sci 2018; 107:1680-1689. [DOI: 10.1016/j.xphs.2018.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 01/07/2023]
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Radhakrishnan ST, Mohanaruban A, Hoque S. Mesalazine-induced myocarditis: a case report. J Med Case Rep 2018; 12:44. [PMID: 29467009 PMCID: PMC5822631 DOI: 10.1186/s13256-017-1557-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 12/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Myocarditis is a rare complication of therapy with mesalazine, a drug widely prescribed in the treatment of inflammatory bowel disease. Case presentation We report a case of myocarditis occurring in a 49-year-old British man 10 days following initiation of mesalazine therapy for treatment of ulcerative colitis. He presented with troponin-positive chest pain, and the diagnosis of myocarditis was confirmed on the basis of cardiac magnetic resonance imaging, which showed subepicardial delayed gadolinium enhancement in the basal to middle inferior and inferolateral segments of the heart. The patient’s symptoms and condition improved upon stopping mesalazine, and he made a full recovery. Conclusions Mesalazine-induced myocarditis may be more common than first appreciated and is potentially fatal. Therefore, it is imperative that clinicians be aware of this potentially life-threatening adverse effect of mesalazine therapy and warn patients to seek urgent medical attention if cardiac symptoms arise.
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Affiliation(s)
| | | | - Sami Hoque
- Barts Health NHS Trust, Whipps Cross University Hospital, London, UK
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16
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Abstract
Drugs are associated frequently with the development of various types of acute and chronic kidney diseases. Nephrotoxicity is associated most commonly with injury in the tubulointerstitial compartment manifested as either acute tubular injury or acute interstitial nephritis. A growing number of reports has also highlighted the potential for drug-induced glomerular disease, including direct cellular injury and immune-mediated injury. Recognition of drug-induced nephropathies and rapid discontinuation of the offending agents are critical to maximizing the likelihood of renal function recovery. This review will focus on the pathology and pathogenesis of drug-induced acute interstitial nephritis and drug-induced glomerular diseases.
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Affiliation(s)
- Paisit Paueksakon
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Lichtenstein GR, Gordon GL, Zakko S, Murthy U, Sedghi S, Pruitt R, Barrett AC, Bortey E, Paterson C, Forbes WP. Long-Term Benefit of Mesalamine Granules for Patients Who Achieved Corticosteroid-Induced Ulcerative Colitis Remission. Dig Dis Sci 2016; 61:221-9. [PMID: 26563167 PMCID: PMC4700064 DOI: 10.1007/s10620-015-3866-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with ulcerative colitis (UC) who achieve remission with corticosteroids often relapse after tapering or discontinuation; alternative treatments limiting steroid exposure and UC relapse would be beneficial. It remains uncertain whether patients with corticosteroid-induced remission experience benefit with mesalamine granules (MG), a locally acting aminosalicylate extended-release capsule formulation for maintenance of UC remission in adults. AIMS Efficacy and safety of MG 1.5 g once daily was evaluated in patients with UC in corticosteroid-induced remission. METHODS Data from patients with previous corticosteroid use to achieve baseline UC remission were analyzed from two 6-month randomized, double-blind, placebo-controlled trials and a 24-month open-label extension (OLE). Six-month relapse-free rates were assessed using the revised Sutherland Disease Activity Index. UC-related adverse events (AEs) were recorded during the 30 months. RESULTS Included were 158 steroid-treated patients in UC remission (MG, n = 105; placebo, n = 53) and 74/105 MG-treated patients who continued MG in the OLE. A significantly larger percentage of patients remained relapse-free at 6 months with MG (77.1 %) versus placebo (54.7 %; P = 0.006), with a 55 % reduction in relapse risk (hazard ratio [HR] 0.45; 95 % CI 0.25-0.79). There was a similar (49.2 %) reduction in risk of UC-related AEs at 6 months (HR 0.51; 95 % CI 0.31-0.84; P = 0.009) that was sustained during the OLE. CONCLUSIONS MG 1.5 g once daily administered for maintenance of corticosteroid-induced remission was associated with low risk of relapse and UC-related AEs. CLINICALTRIALS.GOV: NCT00744016, NCT00767728, and NCT00326209.
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Affiliation(s)
- Gary R. Lichtenstein
- Division of Gastroenterology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 7th Floor Perelman Center, Room 753, 3400 Civic Center Boulevard, Philadelphia, PA 19104 USA
| | | | - Salam Zakko
- Connecticut Gastroenterology Institute and Clinical Research Foundation, Bristol, CT USA
| | - Uma Murthy
- Syracuse VA Medical Center, Syracuse, NY USA
| | - Shahriar Sedghi
- Gastroenterology Associates of Central Georgia, LLC, Macon, GA USA
| | - Ron Pruitt
- Nashville Medical Research Institute, The Maria Nathanson Center at Saint Thomas Hospital, Nashville, TN USA
| | - Andrew C. Barrett
- Salix, a Division of Valeant Pharmaceuticals North America LLC, Bridgewater, NJ USA
| | - Enoch Bortey
- Salix, a Division of Valeant Pharmaceuticals North America LLC, Bridgewater, NJ USA
| | - Craig Paterson
- Salix, a Division of Valeant Pharmaceuticals North America LLC, Bridgewater, NJ USA
| | - William P. Forbes
- Salix, a Division of Valeant Pharmaceuticals North America LLC, Bridgewater, NJ USA
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Ye B, van Langenberg DR. Mesalazine preparations for the treatment of ulcerative colitis: Are all created equal? World J Gastrointest Pharmacol Ther 2015; 6:137-144. [PMID: 26558148 PMCID: PMC4635154 DOI: 10.4292/wjgpt.v6.i4.137] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/24/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Oral mesalazine (also known as mesalamine) is a 5-aminosalicylic acid compound used in the treatment of mild to moderate ulcerative colitis, with high rates of efficacy in induction and maintenance of remission. The therapeutic effect of mesalazine occurs topically at the site of diseased colonic mucosa. A myriad of oral mesalazine preparations have been formulated with various drug delivery methods to minimize systemic absorption and maximise drug availability at the inflamed colonic epithelium. It remains unclear whether different oral mesalazine formulations are bioequivalent. This review aims to evaluate the differences between mesalazine formulations based on the currently available literature and explore factors which may influence the selection of one agent above another.
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Abstract
Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory disorders, which require long term treatment to achieve remission and to prevent relapses and cancer. While current therapies are effective in most cases, they can have rare but serious side effects and are often associated with high costs. On the other hand, early discontinuation of an effective treatment may lead to a quick relapse and to complications at the restart of therapy. Therefore it is essential to determine the optimal duration of maintenance therapy, but clear guidelines are missing. The most important questions when deciding whether to continue or withdraw therapy in quiescent UC and CD patients are the efficacy of the continuous treatment to maintain remission in the long term, the frequency and severity of side effects, and the chance of relapse after discontinuation of therapy. This review summarizes the current knowledge on these topics with respect to 5-aminosalicylates, thiopurines, methotrexate, and biological therapies and collects information regarding when and in which specific patient groups, in the absence of risk factors, can withdrawal of therapy be considered without a high risk of relapse. Additionally, the particular aspect of colorectal cancer prevention by current therapies will also be discussed.
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Accuracy of Rapid Fecal Calprotectin Test in Monitoring Inflammatory Bowel Diseases Under Treatment with TNFα Antagonists. BIOMED RESEARCH INTERNATIONAL 2014; 2014:342751. [PMID: 25478568 PMCID: PMC4251321 DOI: 10.1155/2014/342751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anti-TNFα antibodies are effective in treating inflammatory bowel diseases (IBDs) unresponsive to the standard treatments. Information about the role of rapid fecal calprotectin (FC) in monitoring ambulatory IBD patients under treatment with anti-TNFα is lacking. Our aim was to assess the accuracy of rapid FC in monitoring those patients. METHODS Seventy-two patients (38 males, 34 females, mean age 42.5 years, range 23-57 years), affected by ulcerative colitis (UC) (20 patients) or by Crohn's disease (CD) (52 patients) were treated with anti-TNFα antibodies. FC was assessed by a rapid semiquantitative test. RESULTS With respect to the absence of clinical remission, FC test showed sensitivity of 71.8 %, specificity of 65.2 %, PPV of 41.8 %, and NPV of 86.9 %. In UC patients, FC test showed a sensitivity of 66.7 %, a specificity of 56.1 %, a PPV of 18.2 %, and a NPV of 92.0 %. In CD patients, FC test showed sensitivity of 70.6 %, specificity of 65.2 %, PPV of 50.0 %, and NPV of 81.8 %. With respect to the presence of endoscopic lesions, FC test showed sensitivity of 73.5 %, specificity of 96.0 %, PPV of 96.2 %, and NPV of 72.7 %. In UC patients, FC test showed sensitivity of 47.2 %, specificity of 84.6 %, PPV of 89.5 %, and NPV of 36.7 %. In CD patients, FC test showed sensitivity of 90.1 %, specificity of 79.7 %, PPV of 71.9 %, and NPV of 93.3 %. CONCLUSIONS Diagnostic accuracy of rapid FC seems better in predicting persistence of endoscopic lesions than clinical remission in IBD patients under treatment with anti-TNFα.
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Auffret M, Béné J, Lambert M, Gautier S. [Mesalazine-related interstitial lung disease: an under-diagnosed effect?]. Therapie 2014; 69:531-2. [PMID: 25320942 DOI: 10.2515/therapie/2014205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/03/2014] [Indexed: 11/20/2022]
Abstract
We report the case of a woman treated with adalimumab and mesalazine for a Crohn's disease who presented 9 years after the beginning of the treatments an interstitial lung disease (ILD) discovered by chance during a routine medical examination. Several hypotheses were evocated: progression of the Crohn's disease with a pulmonary involvement then the role of adalimumab was finally suspected. Adalimumab treatment was stopped, but several months later, the pulmonary disease persisted. Six months after the initial medical consult, mesalazine treatment was suspected and stopped. The ILD improved and finally completely resolved with no recurrence after one year. Interstitial lung disease is a rare side effect of mesalazine probably underdiagnosed by physicians especially in patients treated with TNF alpha inhibitors.
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Affiliation(s)
- Marine Auffret
- Centre régional de pharmacovigilance du Nord-Pas-de-Calais, CHRU Lille, Lille, France
| | - Johana Béné
- Centre régional de pharmacovigilance du Nord-Pas-de-Calais, CHRU Lille, Lille, France
| | - Marc Lambert
- Service de médecine interne, CHRU Lille, Lille, France
| | - Sophie Gautier
- Centre régional de pharmacovigilance du Nord-Pas-de-Calais, CHRU Lille, Lille, France
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22
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Lawlor G, Ahmed A, Moss AC. Once-daily mesalamine granules for ulcerative colitis. Expert Rev Clin Immunol 2014; 6:521-6. [DOI: 10.1586/eci.10.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Jacobsson H, Eriksen J, Karlén P. Mesalazine-induced renal calculi. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:551-3. [PMID: 24478817 PMCID: PMC3905811 DOI: 10.12659/ajcr.889719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/25/2013] [Indexed: 11/22/2022]
Abstract
Patient: Female, 32 Final Diagnosis: Renal colic Symptoms: Acute colic pain • macrohematuria Medication: Mesalazine Clinical Procedure: CT scan of urinary tract • cystoscopy • gynecological consultation • stone analysis Specialty: Gastroenterology and Hepatology • Clinical Pharmacology
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Affiliation(s)
- Henrik Jacobsson
- Division of Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Sciences, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Per Karlén
- Division of Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
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Abraham A, Karakurum A. Acute respiratory failure secondary to mesalamine-induced interstitial pneumonitis. BMJ Case Rep 2013; 2013:bcr-2013-009834. [PMID: 23964037 DOI: 10.1136/bcr-2013-009834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Interstitial pneumonitis as an adverse effect of mesalamine therapy is a rare but potentially serious complication. Patients typically have a mild disease course with no documented cases of respiratory failure in published literature. Given its variable latent period and non-specific signs and symptoms, it may be difficult to diagnose. We present the case of a 65-year-old man who presented with symptoms of fever, shortness of breath and a non-productive cough, 2 weeks after initiation of therapy with mesalamine. His hospital course was complicated by acute respiratory failure requiring intubation and mechanical ventilation. Radiographic studies revealed bilateral lower lobe infiltrates and bronchosopy with bronchoalveolar lavage and transbronchial biopsy were consistent with a diagnosis of drug-induced interstitial pneumonitis. The aim of this paper is to highlight the importance of considering a diagnosis of mesalamine-induced lung injury in patients presenting with respiratory symptoms while on mesalamine therapy and to review relevant literature.
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Affiliation(s)
- Albin Abraham
- Nassau University Medical Center, East Meadow, New York, USA
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Nanda K, Moss AC. Update on the management of ulcerative colitis: treatment and maintenance approaches focused on MMX(®) mesalamine. Clin Pharmacol 2012; 4:41-50. [PMID: 22888278 PMCID: PMC3413022 DOI: 10.2147/cpaa.s26556] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease of the colon that typically manifests as diarrhea, abdominal pain, and bloody stool. Complications, such as colorectal cancer and extraintestinal manifestations, may also develop. The goals of management are to induce and maintain clinical remission and to screen for complications of this disease. Mesalamine is a 5-aminosalicylic acid compound that is the first-line therapy to induce and maintain clinical remission in patients with mild-to-moderate UC. For patients who are refractory to mesalamine or have more severe disease, steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab may be used, induce and/or maintain remission. The various formulations of mesalamine available are primarily differentiated by the methods of delivery of the active compound of the drug to the colon. Mesalamine with Multi-Matrix System® (MMX) technology (Cosmo SpA, Milan, Italy) is an oral (1.2 g), once-daily tablet formulation of mesalamine used for the treatment of UC (Lialda® or Mezavant®, Shire Pharmaceuticals Inc, Wayne, PA). In clinical studies, MMX mesalamine (taken as a once-daily dose of 2.4 or 4.8 g) effectively induced and maintained clinical remission in patients with active mild-to-moderate UC. The overall safety profile of MMX mesalamine is similar to other oral mesalamine formulations. The use of such once-daily formulations has led to intense interest in whether simplified pill regimens can improve patient adherence to mesalamine therapy.
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Affiliation(s)
- Kavinderjit Nanda
- Center for Inflammatory Bowel Disease, BIDMC/Harvard Medical School, Boston, MA, USA
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26
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Ham M, Moss AC. Mesalamine in the treatment and maintenance of remission of ulcerative colitis. Expert Rev Clin Pharmacol 2012; 5:113-23. [PMID: 22390554 DOI: 10.1586/ecp.12.2] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ulcerative colitis (UC) is a chronic disease of the GI tract that is characterized by mucosal inflammation in the colon. Mesalamine (mesalazine) is a 5-aminosalicylic acid compound that is the first-line treatment for patients with mild-to-moderate UC. There are multiple formulations of mesalamine available, primarily differentiated by their means of delivering active mesalamine to the colon. Mesalamine has been demonstrated in randomized controlled trials to induce both clinical response and remission, and maintain clinical remission, in these patients. It has few serious adverse effects and is generally well tolerated by patients. The main areas of uncertainty with use of mesalamine in patients with UC center on the optimal dose for induction of response, how to maintain patient adherence and the role of mesalamine in cancer chemoprophylaxis. Generic forms of mesalamine have yet to be approved by regulatory bodies in the USA.
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Affiliation(s)
- Maggie Ham
- Center for Inflammatory Bowel Disease, BIDMC/Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Navaneethan U, Shen B. Pros and cons of medical management of ulcerative colitis. Clin Colon Rectal Surg 2012; 23:227-38. [PMID: 22131893 DOI: 10.1055/s-0030-1268249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease characterized by diffuse mucosal inflammation limited to the colon and rectum. Although a complete medical cure may not be possible, UC can be treated with medications that induce and maintain remission. The medical management of this disease continues to evolve with a goal to avoid colectomy and ultimately alter the natural history of UC. Emergence of antitumor necrosis factor-α (TNF-α) agents has expanded the medical armamentarium. 5-Aminosalicylates continue to be used in mild to moderate UC and corticosteroids are mainly used for induction of remission with immunomodulators (6-mercaptopurine/azathiopurine/methotrexate) being applied as steroid-sparing agents for maintenance therapy. Infliximab has been approved by the U.S. Food and Drug Administration and used in the treatment of moderate to severe UC; nevertheless, its use may be associated with significant adverse effects and have a negative impact on the postoperative course should the patients undergo restorative proctocolectomy. In addition, there is always a concern about patients' compliance to medical therapy, cost of medications, and risk for UC-associated dysplasia. The authors discuss the pros and cons of medications used in the treatment of UC.
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Affiliation(s)
- Udayakumar Navaneethan
- Center for Inflammatory Bowel Disease, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. USA
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Gross V, Bunganic I, Belousova EA, Mikhailova TL, Kupcinskas L, Kiudelis G, Tulassay Z, Gabalec L, Dorofeyev AE, Derova J, Dilger K, Greinwald R, Mueller R. 3g mesalazine granules are superior to 9mg budesonide for achieving remission in active ulcerative colitis: a double-blind, double-dummy, randomised trial. J Crohns Colitis 2011; 5:129-38. [PMID: 21453882 DOI: 10.1016/j.crohns.2010.11.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/16/2010] [Accepted: 11/17/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Budesonide may be an effective therapy for mild-to-moderately active ulcerative colitis (UC). This study aimed to demonstrate non-inferiority for oral 9mg budesonide once daily (OD) versus 3g mesalazine granules OD. METHODS This was an eight-week randomised, double-blind, double-dummy, multicentre study in which patients with mild-to-moderately active UC, defined as Clinical Activity Index (CAI) ≥6 and Endoscopic Index (EI) ≥4, received budesonide (Budenofalk® 3mg capsules×3) or mesalazine (Salofalk® 1000mg granules×3). The primary endpoint was clinical remission at week 8 (CAI ≤4 with stool frequency and rectal bleeding subscores of "0"). RESULTS 343 patients were randomised (177 budesonide, 166 mesalazine). Fewer patients achieved the primary endpoint with budesonide versus mesalazine (70/177 [39.5%] versus 91/166 [54.8%]) with a difference in proportions of -15.3% (95% CI [-25.7%, -4.8%]; p=0.520 for non-inferiority). The median time to first resolution of symptoms was 14.0 days (budesonide) and 11.0 days (mesalazine) (hazard ratio 1.19; 95% CI [0.94, 1.51]). Mucosal healing was observed in 54/177 (30.5%) budesonide patients versus 65/166 (39.2%) mesalazine patients, a difference of -8.6% (95% CI [-18.7%, 1.4%]; p=0.093). The incidences of adverse events (budesonide 26.6%, mesalazine 25.3%) and serious adverse events (budesonide 1.7%, mesalazine 1.2%) were similar. CONCLUSIONS Once-daily 3g mesalazine administered as granules is superior to 9mg budesonide OD administered as capsules for achieving remission in mild-to-moderately active UC. However, it is noteworthy that remission of UC was attained in about 40% of budesonide-treated patients with a rapid onset of resolution.
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Affiliation(s)
- Volker Gross
- Medizinische Klinik II, Klinikum St. Marien, Mariahilfbergweg 5-7, 92224 Amberg, Germany.
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Lichtenstein GR, Gordon GL, Zakko S, Murthy U, Sedghi S, Pruitt R, Merchant K, Shaw A, Bortey E, Forbes WP. Clinical trial: once-daily mesalamine granules for maintenance of remission of ulcerative colitis - a 6-month placebo-controlled trial. Aliment Pharmacol Ther 2010; 32:990-9. [PMID: 20937044 DOI: 10.1111/j.1365-2036.2010.04438.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is a chronic relapsing and remitting idiopathic inflammatory bowel disorder. AIM To evaluate once-daily mesalamine (mesalazine) granules (MG) for maintenance of remission of UC. METHODS Randomized, double-blind, placebo-controlled trial of patients (n=209 MG, n=96 placebo) with UC in remission [revised Sutherland Disease Activity Index (SDAI) rectal bleeding=0, mucosal appearance <2] who took MG 1.5 g or placebo once-daily for up to 6 months. Primary efficacy endpoint: the percentage of patients who remained relapse-free at month 6/end of treatment. Relapse was defined as SDAI rectal bleeding score ≥1 and a mucosal appearance score ≥2, a UC flare, or initiation of medication to treat a UC flare. RESULTS The percentage of relapse-free patients at month 6/end of treatment was higher with MG than placebo (78.9% vs. 58.3%, P < 0.001) in the intent-to-treat analysis. Significant differences (P ≤ 0.025) favouring MG were observed for most secondary endpoints including improvement in rectal bleeding, physician's disease activity rating, stool frequency, the SDAI at month 6/end of treatment, patients classified as a treatment success and relapse-free duration. The incidence of adverse events was similar between groups. CONCLUSIONS Once-daily mesalamine (mesalazine) was effective in maintaining remission of UC for 6 months.
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Affiliation(s)
- G R Lichtenstein
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
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30
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[Differential diagnosis problem of pulmonary changes in ulcerative colitis]. VOJNOSANIT PREGL 2010; 67:511-4. [PMID: 20629432 DOI: 10.2298/vsp1006511d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Inflammatory intestinal diseases are often accompanied with extraintestinal and even pulmonary manifesStations. The treatment of these intestinal diseases includes sulphasalazine and mesalazine, which may have undesirable allergic and other side effects, including hypersensitive pneumonitis. CASE REPORT Having performed colonoscopy due to abdominal pains and mushy stools, the diagnosis of ulcerous colitis was established in a 20-year-old female patient and the treatment with mesalazine initiated. However, the patient developed slimy and bloody stools, slightly increased body temperature, dry cough and bilateral lung lesions. The bronchological exploration established interstitial and organizing pneumonia. Despite the treatment with antibiotics, corticosteroids and mesalazine, dry cough, fever and bloody stools persisted, accompanied with bilateral inhomogeneous lesions of the pulmonary parenchyma. Upon discontinuation of the treatment with mesalazine, clinical symptoms and pulmonary lesions disappeared. CONCLUSION The differential diagnosis of pulmonary lesions in patients with ulcerous colitis may be a problem. In the reported case, pulmonary lesions were interpreted as interstitial pneumonitis accompanying ulcerous colitis. However, they are most probably a consequence of allergic response to mesalazine.
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Sposato B, Allegri MP, Riccardi MP, Chigiotti S, Nencioni C, Ricciardi B, Carli T, Cresti A, Perari MG, Migliorini MG, Toti M. Mesalazine-induced multi-organ hypersensitivity. Clin Drug Investig 2010. [PMID: 20441247 DOI: 10.2165/11535480-000000000-00000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mesalazine therapy for ulcerative colitis has been reported to be effective and safe. Rare cases of mesalazine-induced renal, pancreatic, myo-pericardial, pleuro-pulmonary and haematological toxicity have been described separately. We report a case characterized by the simultaneous presence of fever, pericarditis, peripheral eosinophilia, eosinophilic pneumonia, anaemia and haematuria (together with proteinuria and leukocyturia) due to mesalazine treatment in a patient with ulcerative colitis. No clinical response had been obtained with corticosteroids and various antibacterial agents. When mesalazine treatment was suspended, all symptoms rapidly and totally disappeared, confirming the direct responsibility of this drug in causing these adverse events. We conclude that mesalazine can induce multi-organ hypersensitivity, which must always be considered as a possible adverse effect during treatment with this drug. To resolve this adverse event it is essential to discontinue mesalazine treatment.
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Affiliation(s)
- Bruno Sposato
- Unità Operativa Pneumologia, Ospedale Misericordia Grosseto, Grosseto, Italy.
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Sposato B, Allegri MP, Riccardi MP, Chigiotti S, Nencioni C, Ricciardi B, Carli T, Cresti A, Perari MG, Migliorini MG, Toti M. Mesalazine-induced multi-organ hypersensitivity. Clin Drug Investig 2010; 30:413-7. [PMID: 20441247 DOI: 10.1007/bf03256911] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mesalazine therapy for ulcerative colitis has been reported to be effective and safe. Rare cases of mesalazine-induced renal, pancreatic, myo-pericardial, pleuro-pulmonary and haematological toxicity have been described separately. We report a case characterized by the simultaneous presence of fever, pericarditis, peripheral eosinophilia, eosinophilic pneumonia, anaemia and haematuria (together with proteinuria and leukocyturia) due to mesalazine treatment in a patient with ulcerative colitis. No clinical response had been obtained with corticosteroids and various antibacterial agents. When mesalazine treatment was suspended, all symptoms rapidly and totally disappeared, confirming the direct responsibility of this drug in causing these adverse events. We conclude that mesalazine can induce multi-organ hypersensitivity, which must always be considered as a possible adverse effect during treatment with this drug. To resolve this adverse event it is essential to discontinue mesalazine treatment.
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Affiliation(s)
- Bruno Sposato
- Unità Operativa Pneumologia, Ospedale Misericordia Grosseto, Grosseto, Italy.
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Abstract
Acute interstitial nephritis (AIN) is a common cause of acute kidney injury. Many etiologies of AIN have been recognized--including allergic/drug-induced, infectious, autoimmune/systemic, and idiopathic forms of disease. The most common etiology of AIN is drug-induced disease, which is thought to underlie 60-70% of cases. Multiple agents from many different classes of drugs can cause AIN, and the clinical presentation and laboratory findings vary according to the class of drug involved. AIN is characterized by interstitial inflammation, tubulitis, edema, and in some cases, eventual interstitial fibrosis. A definitive diagnosis of AIN can be established only by kidney biopsy. Noninvasive tests such as (67)gallium scintigraphy and testing for eosinophiluria have limited diagnostic utility. The mainstay of therapy for drug-induced AIN is timely discontinuation of the causative agent. Although the benefits of corticosteroid therapy remain unproven, they do appear to have a positive effect in some patients with drug-induced AIN, especially when treatment is initiated early in the course of the disease. In general, the prognosis for drug-induced AIN is good, and at least partial recovery of kidney function is normally observed. Early recognition is crucial because patients can ultimately develop chronic kidney disease.
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Rosenberg LN, Peppercorn MA. Efficacy and safety of drugs for ulcerative colitis. Expert Opin Drug Saf 2010; 9:573-92. [DOI: 10.1517/14740331003639412] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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5-Aminosalicylic acid inhibits TGF-beta1 signalling in colorectal cancer cells. Cancer Lett 2009; 287:82-90. [PMID: 19541409 DOI: 10.1016/j.canlet.2009.05.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 05/28/2009] [Accepted: 05/29/2009] [Indexed: 01/23/2023]
Abstract
The transforming growth factor-beta (TGF-beta) pathway is an important pathway in the initiation and progression of colorectal cancer. We aimed to determine the effects of 5-aminosalicylic acid (5-ASA) on TGF-beta signalling in colorectal cancer cells in vitro. 5-ASA inhibited TGF-beta1 signalling in HCT116 cells and colonic fibroblasts, as judged by a TGF-beta-specific reporter gene assay, plasminogen activator inhibitor-1 mRNA and protein levels, fibroblast trans-differentiation, Smad3 phosphorylation and nuclear translocation. We conclude that 5-ASA inhibits TGF-beta1 signalling in colorectal cancer cells, and might be a potent adjuvant therapeutic drug, interfering with aberrant TGF-beta signalling in colorectal cancer.
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Atienza Amores M, Martín-Garrido I, García-Contreras R, Varela Aguilar J. Alopecia como reacción adversa de la mesalazina. Rev Clin Esp 2009; 209:153-4. [DOI: 10.1016/s0014-2565(09)70886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fernandez-Becker NQ, Moss AC. Improving delivery of aminosalicylates in ulcerative colitis: effect on patient outcomes. Drugs 2008; 68:1089-103. [PMID: 18484800 DOI: 10.2165/00003495-200868080-00006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Developments in drug delivery technology have expanded the formulations of 5-aminosalicylic acid (5-ASA) available to clinicians over the last 50 years. Delivery of adequate doses of 5-ASA to the colon can be achieved by pH-dependent, delayed-release or pro-drug formulations. Despite some variations in the pharmacokinetics between individual preparations, the clinical effects in induction of response and maintenance of remission in ulcerative colitis appear to be consistent. Direct comparison studies between different preparations have yielded similar results in primary endpoints, although differences in secondary endpoints or post hoc analyses have been noted. The development of delivery methods that allow once-daily administration represents a potential means to improve the low medication adherence rates reported in patients with ulcerative colitis.
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Abstract
5-aminosalicylates remain the first-line treatment for patients with ulcerative colitis. A number of formulations are available for the treatment of active ulcerative colitis, including encapsulated mesalazine and mesalazine in combination with other molecules. Balsalazide is an aminosalicylate prodrug that releases mesalazine in the colon, thus exerting its multiple anti-inflammatory effects in areas of colitis. This review will examine the pharmacological and therapeutic features of balsalazide as an anti-inflammatory agent in ulcerative colitis. The introduction of novel aminosalicylate formulations and an appreciation of their molecular mode of action, has renewed interest in these agents in both maintenance of disease remission and cancer prevention.
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Affiliation(s)
- Seema A Patil
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Hu MY, Peppercorn MA. MMX mesalamine: a novel high-dose, once-daily 5-aminosalicylate formulation for the treatment of ulcerative colitis. Expert Opin Pharmacother 2008; 9:1049-58. [DOI: 10.1517/14656566.9.6.1049] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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