Oral aminosalicylates are well established in the treatment of active mild/moderate ulcerative colitis when the disease is extensive.
Extensive ulcerative colitis is defined as occurring beyond the splenic flexure.
The majority of clinical symptoms relate to disease activity in the distal part of the colon.
Professor Philippe Marteau and colleagues conducted a randomized double blind study investigating if mesalazine enema has additional benefit to oral mesalazine alone.
The research team included 127 ambulatory patients with extensive mild/moderate active ulcerative colitis.
The researchers gave all patients twice daily dosing of 4g/day oral mesalazine for 8 weeks.
| Remission occurred in 64% of the mesalazine enema group vs 43% in placebo|
During the initial 4 weeks, the patients additionally received an enema at bedtime containing 1 g of mesalazine or placebo.
The research team assessed disease activity using the ulcerative colitis disease activity index, with clinical and endoscopic signs at 4 and 8 weeks.
The team noted that remission was obtained in 44% of the mesalazine enema group and in 34% of the placebo enema group at 4 weeks.
Remission was also noted in 64% of the mesalazine enema group versus 43% of the placebo enema group at 8 weeks.
The researchers observed that improvement was obtained in 89% of the mesalazine enema group versus 62% of the placebo enema group at 4 weeks.
In addition, at 8 weeks improvements were observed in 86% of the mesalazine group versus 68% of the placebo enema group.
Professor Marteau's team concludes, “In patients with extensive mild/moderate active ulcerative colitis, the combination therapy is superior to oral therapy.”
“It is safe, well accepted, and may be regarded as firstline treatment.”