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European Review For Medical and... Aug 2020Diverticulitis is the most severe form of Diverticular disease (DD). An effective treatment strategy for its prevention has not yet been defined. This review aimed to... (Review)
Review
Diverticulitis is the most severe form of Diverticular disease (DD). An effective treatment strategy for its prevention has not yet been defined. This review aimed to provide a viewpoint on the role of mesalazine, also note as 5-aminosalicylic acid (5-ASA), in the prevention of diverticulitis. A systematic electronic search of relevant articles was performed using PubMed, Embase, Scopus, and Cochrane. Randomized controlled trials (RCTs), open trials, and retrospective studies, published between January 1999 and January 2020, were identified. Twelve eligible studies that analyzed primary or secondary outcomes of diverticulitis were included. The population included patients with symptomatic uncomplicated diverticular disease (SUDD), or patients with a history of diverticulitis. All studies compared 5-ASA to placebo, rifaximin, or other treatments. Two studies, including 359 patients, assessed the efficacy of 5-ASA in preventing the first appearance of diverticulitis in patients with SUDD. Of these, one showed that 5-ASA was effective, and one did not. Ten studies, including 2.995 patients, assessed the efficacy of 5-ASA treatment in preventing the recurrence of diverticulitis in patients with a history of diverticulitis. Four studies showed that 5-ASA had a certain degree of efficacy. All four RCTs demonstrated that 5-ASA did not significantly reduce the rate of diverticulitis recurrence. In a retrospective trial, 5-ASA was less effective than rifaximin in preventing diverticulitis recurrence. In an open trial, there was no difference between 5-ASA and probiotic treatment. Overall, there is currently conflicting evidence regarding the efficacy of 5-ASA treatment in the prevention of diverticulitis and further RCTs are needed.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Diverticulitis; Humans; Mesalamine; Probiotics; Rifaximin
PubMed: 32767345
DOI: 10.26355/eurrev_202008_22504 -
Gut Jan 2016
Topics: Anti-Inflammatory Agents, Non-Steroidal; Diarrhea; Female; Humans; Irritable Bowel Syndrome; Male; Mesalamine
PubMed: 25873641
DOI: 10.1136/gutjnl-2015-309593 -
Journal of Medical Case Reports Feb 2018Myocarditis is a rare complication of therapy with mesalazine, a drug widely prescribed in the treatment of inflammatory bowel disease.
BACKGROUND
Myocarditis is a rare complication of therapy with mesalazine, a drug widely prescribed in the treatment of inflammatory bowel disease.
CASE PRESENTATION
We report a case of myocarditis occurring in a 49-year-old British man 10 days following initiation of mesalazine therapy for treatment of ulcerative colitis. He presented with troponin-positive chest pain, and the diagnosis of myocarditis was confirmed on the basis of cardiac magnetic resonance imaging, which showed subepicardial delayed gadolinium enhancement in the basal to middle inferior and inferolateral segments of the heart. The patient's symptoms and condition improved upon stopping mesalazine, and he made a full recovery.
CONCLUSIONS
Mesalazine-induced myocarditis may be more common than first appreciated and is potentially fatal. Therefore, it is imperative that clinicians be aware of this potentially life-threatening adverse effect of mesalazine therapy and warn patients to seek urgent medical attention if cardiac symptoms arise.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Humans; Magnetic Resonance Imaging; Male; Mesalamine; Middle Aged; Myocarditis
PubMed: 29467009
DOI: 10.1186/s13256-017-1557-z -
Fundamental & Clinical Pharmacology Feb 2021
Targeting IL-10, ZO-1 gene expression and IL-6/STAT-3 trans-signalling by a combination of atorvastatin and mesalazine to enhance anti-inflammatory effects and attenuate progression of oxazolone-induced colitis.
Topics: Anti-Inflammatory Agents; Atorvastatin; Colitis; Gene Expression; Humans; Interleukin-10; Interleukin-6; Mesalamine; Oxazolone
PubMed: 33289917
DOI: 10.1111/fcp.12638 -
Expert Review of Gastroenterology &... Apr 20085-aminosalicylates remain the first-line treatment for patients with ulcerative colitis. A number of formulations are available for the treatment of active ulcerative... (Review)
Review
5-aminosalicylates remain the first-line treatment for patients with ulcerative colitis. A number of formulations are available for the treatment of active ulcerative colitis, including encapsulated mesalazine and mesalazine in combination with other molecules. Balsalazide is an aminosalicylate prodrug that releases mesalazine in the colon, thus exerting its multiple anti-inflammatory effects in areas of colitis. This review will examine the pharmacological and therapeutic features of balsalazide as an anti-inflammatory agent in ulcerative colitis. The introduction of novel aminosalicylate formulations and an appreciation of their molecular mode of action, has renewed interest in these agents in both maintenance of disease remission and cancer prevention.
Topics: Colitis, Ulcerative; Gastrointestinal Agents; Humans; Mesalamine; Phenylhydrazines
PubMed: 19072352
DOI: 10.1586/17474124.2.2.177 -
Alimentary Pharmacology & Therapeutics Oct 2010Ulcerative colitis (UC) is a chronic relapsing and remitting idiopathic inflammatory bowel disorder. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Ulcerative colitis (UC) is a chronic relapsing and remitting idiopathic inflammatory bowel disorder.
AIM
To evaluate once-daily mesalamine (mesalazine) granules (MG) for maintenance of remission of UC.
METHODS
Randomized, double-blind, placebo-controlled trial of patients (n=209 MG, n=96 placebo) with UC in remission [revised Sutherland Disease Activity Index (SDAI) rectal bleeding=0, mucosal appearance <2] who took MG 1.5 g or placebo once-daily for up to 6 months. Primary efficacy endpoint: the percentage of patients who remained relapse-free at month 6/end of treatment. Relapse was defined as SDAI rectal bleeding score ≥1 and a mucosal appearance score ≥2, a UC flare, or initiation of medication to treat a UC flare.
RESULTS
The percentage of relapse-free patients at month 6/end of treatment was higher with MG than placebo (78.9% vs. 58.3%, P < 0.001) in the intent-to-treat analysis. Significant differences (P ≤ 0.025) favouring MG were observed for most secondary endpoints including improvement in rectal bleeding, physician's disease activity rating, stool frequency, the SDAI at month 6/end of treatment, patients classified as a treatment success and relapse-free duration. The incidence of adverse events was similar between groups.
CONCLUSIONS
Once-daily mesalamine (mesalazine) was effective in maintaining remission of UC for 6 months.
Topics: Adult; Colitis, Ulcerative; Double-Blind Method; Female; Hemorrhage; Humans; Male; Mesalamine; Middle Aged; Mucous Membrane; Rectum; Recurrence
PubMed: 20937044
DOI: 10.1111/j.1365-2036.2010.04438.x -
Expert Opinion on Drug Safety Mar 2007Mesalazine is a 5-aminosalicylic acid compound that is the primary treatment for mild-to-moderate ulcerative colitis. In both oral and topical formulations it has... (Review)
Review
Mesalazine is a 5-aminosalicylic acid compound that is the primary treatment for mild-to-moderate ulcerative colitis. In both oral and topical formulations it has demonstrated efficacy in both induction of active colitis and maintenance of remission, regardless of the extent of inflammation. In addition, there is indirect evidence of a role in the chemoprophylaxis of colorectal cancer in these patients. Mesalazine is generally well tolerated by patients, although serious adverse effects have been reported. In particular, worsening of colitis, interstitial pneumonitis and nephritis are of concern to clinicians. Fortunately these reactions are mostly reversible with cessation of therapy.
Topics: Animals; Colitis, Ulcerative; Humans; Mesalamine; Risk Factors
PubMed: 17367256
DOI: 10.1517/14740338.6.2.99 -
Canadian Journal of Gastroenterology =... Feb 20105-aminosalicylic acid (5-ASA) preparations (eg, mesalazine, mesalamine) are well-established preparations used in the management of inflammatory bowel disease. These... (Review)
Review
5-aminosalicylic acid (5-ASA) preparations (eg, mesalazine, mesalamine) are well-established preparations used in the management of inflammatory bowel disease. These drugs are most useful for the treatment of mild to moderate flares of ulcerative colitis and, especially, for maintenance of remission. Although most gastroenterologists are very familiar with these drugs, the interest in these drugs has undergone a resurgence, with new preparations offering convenience and high dosage, while preserving their customary safety. New dosage regimens are likely to become standard practice in the near future. There is also considerable interest in chemoprevention of colorectal cancer in the context of inflammatory bowel disease, and the role of long-term maintenance therapy with 5-ASAs in achieving such chemoprevention. A mechanism of action for such chemoprevention has been provided by the agonism of the peroxisome proliferator-activated receptor-gamma by 5-ASA, which unifies its efficacy as an anti-inflammatory and chemopreventive agent. In the future, even more effective agents based on 5-ASA are expected, based on more powerful agonism of peroxisome proliferator-activated receptor-gamma; 5-ASA preparations have become 'trendy' again.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Colorectal Neoplasms; Crohn Disease; Humans; Mesalamine; PPAR gamma; Remission Induction; Tablets
PubMed: 20151072
DOI: 10.1155/2010/586092 -
International Journal of Molecular... Sep 2013Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide. Although conclusive evidence is still lacking, epidemiologic studies suggest that... (Review)
Review
Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide. Although conclusive evidence is still lacking, epidemiologic studies suggest that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) has chemopreventive properties against CRC. Similarly, regular consumption of mesalazine, a drug structurally related to NSAIDs, seems to reduce the risk of CRC in patients with ulcerative colitis. These observations are supported by a large body of experimental data showing the ability of such drugs to inhibit multiple pathways that sustain colon carcinogenesis. This review summarizes the current information on the molecular mechanisms by which NSAIDs and mesalazine could interfere with CRC cell growth and survival.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Chemoprevention; Colorectal Neoplasms; Humans; Mesalamine
PubMed: 24005861
DOI: 10.3390/ijms140917972 -
Alimentary Pharmacology & Therapeutics May 2003Products containing mesalazine have been used in the treatment of inflammatory bowel disease for many years. Many of the oral, modified-release products are reaching the... (Review)
Review
Products containing mesalazine have been used in the treatment of inflammatory bowel disease for many years. Many of the oral, modified-release products are reaching the point of patent expiration, and it is expected that several new 'generic' versions will be developed. As mesalazine acts topically, the drug needs to be available at the site of inflammation to be effective. For this reason, the currently available products have been developed with individual formulations so that physicians have a choice when matching the different release profiles to the site and extent of disease. As such, the current guidelines state that oral, delayed-release mesalazine formulations are not interchangeable and should be prescribed by their proprietary (brand) name. The standard regulatory assessment process for generic or 'copy' products, using systemic bioequivalence data, does not appear to be sufficient when evaluating topically acting, oral, modified-release products. We therefore recommend that the regulatory bodies should require that new, oral mesalazine products should be assessed by a combination of dissolution, bioequivalence and (a minimum of one) adequately powered, comparative trial to determine therapeutic equivalence. Of most importance here is that the assessment of new modified-release products is sufficiently rigorous to allow patients and physicians to be confident in their use.
Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Crohn Disease; Drugs, Generic; Humans; Inflammatory Bowel Diseases; Mesalamine; Therapeutic Equivalency
PubMed: 12755834
DOI: 10.1046/j.1365-2036.2003.01578.x