Year 2017 / Volume 109 / Number 2
Original
What is the real-life maintenance mesalazine dose in ulcerative colitis?

114-121

DOI: 10.17235/reed.2016.4620/2016

Alicia Algaba, Iván Guerra, Ana García García de Paredes, María Hernández Tejero, Carlos Ferre, Daniel Bonillo, Lara Aguilera, Antonio López-Sanromán, Fernando Bermejo,

Abstract
Objective: To describe how mesalazine (MSZ) is used in our practice in ulcerative colitis (UC), at what dose, and the success rate (regarding adherence to therapy). Methods: Observational, transversal study, including all patients with UC and with MSZ maintenance therapy seen from September 2014 to February 2015 at two IBD units in Spain. Treatment adherence was measured by the Morisky-Green scale. Results: We included 203 patients (mean MSZ dose: 2.6 ± 1.0 g/d; median of treatment: 19.5 months [IQR: 8-48]). Doses < 2 g/d were used in 15.3% of cases, 2-2.9 g/d doses in 35.0%, 3-3.9 doses in 29.5%, and ≥ 4 g/d doses in the remaining 20.2%. A single daily dose was preferred in 51.2% of cases, two doses in 33.0% and three doses in 15.8%. A different MSZ brand had been previously used in 36.6% of patients. In 134 cases (66%), the maintenance dose had been increased during a flare-up, and in 49 (36.6% of cases) this higher dose had been kept for maintenance (dose ≥ 4 g/d in 36 patients). During the MSZ therapy, 14 patients (6.9%) suffered mild side effects (21.4% altered liver function tests). Therapy adherence was good in 81.8% of cases. Conclusions: Half of our UC patients take high MSZ doses (≥ 3 g/d) as maintenance therapy, with acceptable safety and good adherence. Half of all patients take a single daily dose, and one third needed a different commercial brand during therapy. Opting for a higher MSZ maintenance dose is a possible strategy for a satisfactory maintenance therapy.
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References
1. Monstad I, Hovde O, Solberg IC, et al. Clinical course and prognosis in ulcerative colitis: results from population-based and observational studies. Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology. 2014;27(2):95-104.
2. Jess T, Riis L, Vind I, et al. Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark. Inflammatory bowel diseases. 2007;13(4):481-9.
3. Manosa M, Domenech E. [Mesalazine old and new]. Gastroenterologia y hepatologia. 2011;34 Suppl 3:25-9.
4. Grinspan A, Kornbluth A. Positioning Therapy for Ulcerative Colitis. Current gastroenterology reports. 2015;17(8):29.
5. Chaparro M, Gisbert JP. Maintenance therapy options for ulcerative colitis. Expert Opin Pharmacother. 2016:1-11.
6. Wang Y, Parker CE, Bhanji T, et al. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2016;4:CD000543.
7. Desreumaux P, Ghosh S. Review article: mode of action and delivery of 5-aminosalicylic acid - new evidence. Alimentary pharmacology & therapeutics. 2006;24 Suppl 1:2-9.
8. Bohm SK, Kruis W. Long-term efficacy and safety of once-daily mesalazine granules for the treatment of active ulcerative colitis. Clinical and experimental gastroenterology. 2014;7:369-83.
9. Gordon GL, Zakko S, Murthy U, et al. Once-daily Mesalamine Formulation for Maintenance of Remission in Ulcerative Colitis: A Randomized, Placebo-controlled Clinical Trial. Journal of clinical gastroenterology. 2015.
10. Dignass A, Lindsay JO, Sturm A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. Journal of Crohn's & colitis. 2012;6(10):991-1030.
11. Lennard-Jones JE. Classification of inflammatory bowel disease. Scandinavian journal of gastroenterology Supplement. 1989;170:2-6; discussion 16-9.
12. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2005;19 Suppl A:5A-36A.
13. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. The New England journal of medicine. 1987;317(26):1625-9.
14. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical care. 1986;24(1):67-74.
15. Pica R, Cassieri C, Cocco A, et al. A randomized trial comparing 4.8 vs. 2.4 g/day of oral mesalazine for maintenance of remission in ulcerative colitis. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2015;47(11):933-7.
16. Fockens P, Mulder CJ, Tytgat GN, et al. Comparison of the efficacy and safety of 1.5 compared with 3.0 g oral slow-release mesalazine (Pentasa) in the maintenance treatment of ulcerative colitis. Dutch Pentasa Study Group. European journal of gastroenterology & hepatology. 1995;7(11):1025-30.
17. Paoluzi OA, Iacopini F, Pica R, et al. Comparison of two different daily dosages (2.4 vs. 1.2 g) of oral mesalazine in maintenance of remission in ulcerative colitis patients: 1-year follow-up study. Alimentary pharmacology & therapeutics. 2005;21(9):1111-9.
18. Lichtenstein GR, Gordon GL, Zakko S, et al. Clinical trial: once-daily mesalamine granules for maintenance of remission of ulcerative colitis - a 6-month placebo-controlled trial. Alimentary pharmacology & therapeutics. 2010;32(8):990-9.
19. Li W, Zhang ZM, Jiang XL. Once daily versus multiple daily mesalamine therapy for mild to moderate ulcerative colitis: a meta-analysis. Colorectal Dis. 2016.
20. Hanauer SB, Sandborn WJ, Dallaire C, et al. Delayed-release oral mesalamine 4.8 g/day (800 mg tablets) compared to 2.4 g/day (400 mg tablets) for the treatment of mildly to moderately active ulcerative colitis: The ASCEND I trial. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2007;21(12):827-34.
21. Hanauer SB, Sandborn WJ, Kornbluth A, et al. Delayed-release oral mesalamine at 4.8 g/day (800 mg tablet) for the treatment of moderately active ulcerative colitis: the ASCEND II trial. Am J Gastroenterol. 2005;100(11):2478-85.
22. Lichtenstein GR, Ramsey D, Rubin DT. Randomised clinical trial: delayed-release oral mesalazine 4.8 g/day vs. 2.4 g/day in endoscopic mucosal healing--ASCEND I and II combined analysis. Alimentary pharmacology & therapeutics. 2011;33(6):672-8.
23. Takeshima F, Matsumura M, Makiyama K, et al. Efficacy of long-term 4.0 g/day mesalazine (Pentasa) for maintenance therapy in ulcerative colitis. Med Sci Monit. 2014;20:1314-8.
24. Rubin DT, Bradette M, Gabalec L, et al. Ulcerative Colitis Remission Status After Induction With Mesalazine Predicts Maintenance Outcomes: the MOMENTUM Trial. Journal of Crohn's & colitis. 2016.
25. Klotz U, Maier K, Fischer C, et al. Therapeutic efficacy of sulfasalazine and its metabolites in patients with ulcerative colitis and Crohn's disease. The New England journal of medicine. 1980;303(26):1499-502.
26. Feagan BG, Macdonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2012;10:CD000543.
27. Loftus EV, Jr., Kane SV, Bjorkman D. Systematic review: short-term adverse effects of 5-aminosalicylic acid agents in the treatment of ulcerative colitis. Alimentary pharmacology & therapeutics. 2004;19(2):179-89.
28. Suzuki Y, Iida M, Ito H, et al. Efficacy and safety of two pH-dependent-release mesalamine doses in moderately active ulcerative colitis: a multicenter, randomized, double-blind, parallel-group study. Intest Res. 2016;14(1):50-9.
29. Ford AC, Khan KJ, Sandborn WJ, et al. Once-daily dosing vs. conventional dosing schedule of mesalamine and relapse of quiescent ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(12):2070-7; quiz 8.
30. Zakko SF, Gordon GL, Murthy U, et al. Once-daily mesalamine granules for maintaining remission of ulcerative colitis: pooled analysis of efficacy, safety, and prognostic factors. Postgraduate medicine. 2016.
31. Van Staa TP, Travis S, Leufkens HG, et al. 5-aminosalicylic acids and the risk of renal disease: a large British epidemiologic study. Gastroenterology. 2004;126(7):1733-9.
32. Gisbert JP, Gonzalez-Lama Y, Mate J. 5-Aminosalicylates and renal function in inflammatory bowel disease: a systematic review. Inflammatory bowel diseases. 2007;13(5):629-38.
33. Bermejo F, Lopez-San Roman A, Algaba A, et al. Factors that modify therapy adherence in patients with inflammatory bowel disease. Journal of Crohn's & colitis. 2010;4(4):422-6.
34. Coenen S, Weyts E, Ballet V, et al. Identifying predictors of low adherence in patients with inflammatory bowel disease. European journal of gastroenterology & hepatology. 2016;28(5):503-7.
35. Haase J, Farris KB, Dorsch MP. Mobile Applications to Improve Medication Adherence. Telemed J E Health. 2016.
36. Lopez-Sanroman A, Bermejo F. Review article: how to control and improve adherence to therapy in inflammatory bowel disease. Alimentary pharmacology & therapeutics. 2006;24 Suppl 3:45-9.
37. Robinson A. Review article: improving adherence to medication in patients with inflammatory bowel disease. Alimentary pharmacology & therapeutics. 2008;27 Suppl 1:9-14.
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Algaba A, Guerra I, García García de Paredes A, Hernández Tejero M, Ferre C, Bonillo D, et all. What is the real-life maintenance mesalazine dose in ulcerative colitis?. 4620/2016


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Publication history

Received: 14/09/2016

Accepted: 05/11/2016

Online First: 27/12/2016

Published: 31/01/2017

Article revision time: 46 days

Article Online First time: 104 days

Article editing time: 139 days


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