Mesalazine foam (Salofalk (R) foam) in the treatment of active distal ulcerative colitis. A comparative trial vs Salofalk (R) enema

Background. Mesalazine Enemas are of well proven efficacy for the topical t reatment of distal ulcerative colitis. Although new rectal formulations of mesalazine are not expected to be superior in efficacy and tolerability to standard formulations, they may offer secondary advantages in terms of over all acceptability. Aim. To compare the efficacy: tolerability and overall acceptability, of a new mesalazine rectal foam (Salofalk((R)) foam) with mesalazine enema in th e treatment of active distal ulcerative colitis. Patients and Methods. A multicentre study was carried out in patients with active proctitis, proctosigmoiditis and left-sided ulcerative colitis as ev aluated by the Clinical Activity Index (CAI greater than or equal to 4) and Endoscopic Index (EI greater than or equal to 6). Patients were randomly a ssigned to receive, in open-label fashion, either mesalazine foam 2 g twice a day or mesalazine enema (2 g/60 mi twice a day) for 3 weeks. Patients wh o did not achieve remission (defined as CAI <4 and EI <6) after 3 weeks con tinued the study receiving the alternative galenic formulation for a furthe r 3 weeks. Results, A total of 195 patients were enrolled. Characteristics at baseline were similar except for concomitant therapy with oral 5-ASA products: duri ng the 1(st) treatment phase, 41% of patients on enema received such treatm ent vs only 29% of those on foam. Patients with at least one post-treatment efficacy evaluation were included in the intent-to-treat analysis (n=89 fo am, n=96 enema). After 3 weeks of treatment, 112 patients were in remission and only 59 patients entered the 2(nd) treatment phase thus providing data on acceptability. Remission was achieved after 3 weeks in 54% of patients treated with foam and in 67% of those treated with enema. The 90% confidenc e interval for the difference in remission rates was 0 to 24 and thus withi n the clinically acceptable range of therapeutic equivalence. At the end of the 2(nd) phase, 70% of patients switched to foam were in remission vs 65% to the enema, Two patients discontinued treatment with foam prematurely du e to anal bunting. No clinically important changes were seen in the laborat ory tests. Conclusions. Salofalk((R)) foam and enema are equally effective for the tre atment of proctitis, proctosigmoiditis and left-sided ulcerative colitis. T he new foam preparation is as well tolerated and accepted as enemas and can be used as a therapeutic alternative to conventional mesalazine enema form ulations.