Oral delayed-release mesalazine - A review of its use in ulcerative colitis and Crohn's disease

Oral delayed-release messlazine is an enteric-coated formulation which rele ases mesalazine in the terminal ileum and colon. Up to 74% of patients with mild to moderately active ulcerative colitis exp erience endoscopic or symptomatic improvement (including remission) or both when treated with oral delayed-release mesalazine 2.3 to 4.8 g/day. There is a trend towards a better response in patients receiving higher daily dos ages of oral delayed-release mesalazine, especially in patients with active distal disease. In patients with left-sided ulcerative colitis, oral balsa lazide 6.75 g/day appears to be more effective than oral delayed-release me salazine 2.4 g/day, but a higher dosage of oral delayed-release mesalazine 4.8 g/day may provide additional benefit in these patients. Oral delayed-release mesalazine 0.8 to 4.4 g/day appears to he as effective as sulfasalazine 2 to 4 g/day, prolonged-release mesalazine 1.5 g/day or b alsalazide 3 g/day in maintaining remission in patients with ulcerative col itis. The optimal dosage of oral delayed-release mesalazine for the mainten ance of remission is unclear. However, oral delayed-release mesalazine 1.6 g/day with rectal mesalazine 4g, administered twice weekly, was more effect ive than oral drug alone in maintaining remission in patients at high risk of relapse. In patients with left-sided or distal disease oral olsalazine I g/day appeared to be superior to oral delayed-release mesalazine 1.2 g/day for maintenance of symptomatic remission. Limited data in patients with Crohn's disease have shown oral delayed-relea se mesalazine 0.4 to 4.8 g/day to be an effective therapy for active diseas e (remission in up to 45% of patients) and for quiescent disease (relapse i n 34% of recipients over a duration of up to 12 months), preliminary data i ndicate that oral delayed-release mesalazine 2.4 g/day is effective in prev enting postoperative recurrence of Crohn's disease, Oral delayed-release me salazine is effective and well tolerated in sulfasalazine-intolerant patien ts with ulcerative colitis or Crohn's disease. Conclusions: Oral delayed-release mesalazine is effective in patients with mild to moderately active or quiescent ulcerative colitis. Available data s uggest that patients with left-sided or distal ulcerative colitis are likel y to require higher daily dosages of oral delayed-release mesalazine or sup plementation with rectal mesalazine. Oral delayed-release mesalazine also a ppears to be effective in active and quiescent Crohn's disease. The drug is well tolerated and it appears to be effective in sulfasalazine-intolerant patients.