Cr. Bonapace et Da. Mays, THE EFFECT OF MESALAMINE AND NICOTINE IN THE TREATMENT OF INFLAMMATORY BOWEL-DISEASE, The Annals of pharmacotherapy, 31(7-8), 1997, pp. 907-913
OBJECTIVE: TO characterize the usefulness of mesalamine and nicotine i
n the treatment of active ulcerative colitis and inactive Crohn's dise
ase. DATA SOURCES: Citations were selected from the MEDLINE database.
Only those involving human subjects, inflammatory bowel disease, and a
vailable in English were selected. STUDY SELECTION: Selection criteria
consisted of clinical trials and review articles assessing the effect
s of mesalamine and nicotine in active ulcerative colitis or inactive
Crohn's disease and the utility of reducing steroid dependence or rela
pse rate. Less than 20% of the articles identified met the selection c
riteria. DATA SYNTHESIS: In patients with inactive Crohn's disease, me
salamine 2 g/d significantly reduced the risk of relapse in high-relap
se-risk patients compared with placebo, reducing the relapse rate from
71% to 55%, but was ineffective in preventing recurrence of inactive
Crohn's disease following surgical resection. Mesalamine 4 g/d was eff
ective in decreasing weaning failure due to steroid dependence by 67%,
although the relapse rate was not significant compared with placebo a
t the end of 12 months. Following surgical resection, mesalamine was u
nable to significantly reduce the incidence of recurrence compared wit
h placebo at the end of 1 year. in patients with active ulcerative col
itis, oral mesalamine 2 and 4 g/d was superior to placebo in inducing
remission compared with placebo. Among patients with prior steroid or
sulfasalazine treatment, rectal mesalamine 4 g hs achieved a remission
rate of 78% in more than 12 weeks of therapy. Other studies have not
found a dose-response relationship with lower dosages of mesalamine. W
hereas nicotine 15-25 mg/d administered as a transdermal patch produce
d greater symptomatic improvement in active ulcerative colitis compare
d with placebo, nicotine 15 mg/16 h produced results no different from
those with placebo in maintaining remission in inactive ulcerative co
litis. Nicotine appears to have an adverse effect on the course of Cro
hn's disease and is not recommended. CONCLUSIONS: Mesalamine has demon
strated clinical effectiveness as a therapeutic agent in the treatment
of active ulcerative colitis and inactive Crohn's disease. Although i
ts relationship to inflammatory bowel disease has been known for many
years, the usefulness of nicotine for the treatment of active ulcerati
ve colitis requires further exploration before it can be recommended a
s a therapeutic agent.