MESALAMINE IN PEDIATRIC INFLAMMATORY BOWEL-DISEASE - A 10-YEAR EXPERIENCE

Mesalamine is an enteric-coated 5-aminosalicylic acid formulation effe ctive in the treatment of ulcerative colitis, and in decreasing the re lapse rate in Crohn's disease. However, little data are available rega rding its use in children and adolescents. To determine the modalities of use, safety, and the optimal dose in this age group, charts of 153 pediatric patients with inflammatory bowel disease treated with mesal amine were reviewed, representing >150 patient years of use. Among the se, more than half of the children diagnosed with Crohn's disease (120 patients) had ileocolonic involvement, and pancolitis predominated in those with ulcerative colitis (33 patients). Patients with ulcerative colitis were diagnosed at a younger age than those with Crohn's disea se, and thus mesalamine therapy was initiated earlier. When used as mo notherapy, no difference was noted in the average dose used for the tr eatment of active disease versus maintenance therapy (36 mg/kg/day). H owever, the average dose used did increase since 1992, for both the tr eatment of active disease and relapse prevention (43 mg/kg/day). Overa ll, 18 patients (11.8%) were withdrawn from mesalamine therapy; howeve r only 8 (5.2%) had objective side effects. Exacerbation of diarrhea w as the most common reason for withdrawal. Although reported rarely, no serious adverse reactions such as pancreatitis or hepatic or renal dy sfunction were observed. This study suggests that mesalamine is a safe and well-tolerated medication in the long-term treatment of pediatric patients with ulcerative colitis and Crohn's disease.