THE EFFECT OF MESALAMINE AND NICOTINE IN THE TREATMENT OF INFLAMMATORY BOWEL-DISEASE

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.