Medical treatment of ulcerative colitis

Current Opinion in Gastroenterology

Volumn 12, Issue 4, 1996, Pages 352-355

  Gionchetti, Paolo ^a   Campieri, Massimo ^a  

^a UNIVERSITY OF BOLOGNA   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

ALPHA INTERFERON; CYCLOSPORIN; HEPARIN; IMMUNOSUPPRESSIVE AGENT; MESALAZINE; SALICYLIC ACID DERIVATIVE; SHORT CHAIN FATTY ACID; STEROID;

COLITIS; DRUG EFFICACY; HUMAN; INTRAVENOUS DRUG ADMINISTRATION; LONG TERM CARE; MAINTENANCE THERAPY; ORAL DRUG ADMINISTRATION; RELAPSE; REMISSION; REVIEW; TOPICAL DRUG ADMINISTRATION; ULCERATIVE COLITIS;

EID: 0029792238     PISSN: 02671379     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001574-199607000-00007     Document Type: Review

References (25)

1. Kornbluth A, Marion JF, Salomon P, Janowitz HD: How effective is current medical therapy for severe ulcerative and Crohn's colitis? J Clin Gastroenterol 1995, 20:280-284. This is an interesting analytical review of seven selected trials of medical therapy for severe ulcerative colitis. Using an intensive intravenous regimen, clinical remission was reported in 62% of patients.
2. Lichtiger S, Present DH, Kornbluth A, Gelernt I, Bauer J, Galler G, Michelassi F, Hanauer S: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994, 330:1846-1851.
3. Santos J, Baudet S, Casellas F, Guarner L, Vilaseca J, Malagelada JR: Efficacy of intravenous cyclosporine for steroid refractory attacks of ulcerative colitis. J Clin Gastroenterol 1995, 20:285-289. The use of intravenous cyclosporine (5 mg/kg/d) in patients with steroid-refractory severe ulcerative colitis led to improvement in 76% of patients. Maintenance treatment with oral cyclosporine sustained remission in 10 of 16 patients who responded, but one patient died from infective complications. This study confirms the value of intravenous cyclosporine for treatment of steroid-refractory severe ulcerative colitis. However, the risk of complications during a prolonged treatment should not be forgotten.
4. Bertschinger P, Himmelmann A, Risti B, Follath F: Cyclosporine treatment of severe ulcerative colitis during pregnancy. Am J Gastroenterol 1995, 90:330.
5. Treem WR, Cohen J, Davis P M, Justinich CJ, Hyams JS: Cyclosporine for the treatment of fulminant ulcerative colitis in children. Dis Colon Rectum 1995, 38:474-479. This study confirms the value of intravenous cyclosporine given orally at the dosage 4.6 to 9.6 mg/kg/d in children with fulminant attacks of ulcerative colitis. Cyclosporine produced rapid improvement of symptoms and prevented colectomy, an important goal in the management of ulcerative colitis in children.
6. Gold DM, Levine JJ, Weinstein TA, Kessler B, Pettei MJ: Prolonged medical therapy for severe pediatric ulcerative colitis. Am J Gastroenterol 1995, 90:732-735. Interesting retrospective review suggesting the role of prolonged corticosteroid treatment in children with severe colitis.
7. Gaffney PR, Dojle CT, Path FRC, Gaffney A, Hogan J, Path FRC, Hayes DP, Annis P: Paradoxical response to heparin in 10 patients with ulcerative colitis. Am J Gastroenterol 1995, 90:220-223. Uncontrolled study showing the efficacy of subcutaneous heparin in treating patients with ulcerative colitis refractory to standard therapy. Of the 10 patients treated, nine became asymptomatic and one had a partial improvement. Mean time to remission was 6 weeks. No serious side effects were observed. Interesting results that must be confirmed in a controlled trial.
8. Sümer N, Palabiyikoglu M: Induction of remission by interferon-α in patients with chronic active ulcerative colitis. Eur J Gastroenterol Hepatol 1995, 7:597-602. Open-label study on the use of interferon alfa-2a (6 MIU three times a week) in the treatment of patients with severe refractory ulcerative colitis. Of the 28 patients, 23 (82%) responded to treatment within 15 days and were in complete clinical and endoscopic remission after 6 months. No serious side effects were observed.
9. Bitton A, Peppercorn MA: Medical therapy of ulcerative proctitis and proctosigmoiditis, including refractory disease, Inflamm Bowel Dis 1995, 1:207-219. Clinical review confirming the primary role of topical treatment for patients with proctitis and proctosigmoiditis.
10. Farup PG, Halvorsen FA, Raknerud N, Brodin U: Mesalazine suppositories versus hydrocortisone foam in patients with distal ulcerative colitis. Scand J Gastroenterol 1995, 30:164-170. Efficacy, safety, and practicality of 4 weeks' treatment with 500 mg of 5-ASA suppositories twice daily or 178 mg of hydrocortisone foams twice daily were compared in 79 patients with proctitis or proctosigmoiditis. Both treatment regimens were effective, but 5-ASA suppositories appeared be the preferred alternative.
11. Bianchi-Porro G, Ardizzone S, Petrillo M, Fasoli A, Molteni P, Imbesi V: Low Pentasa dosage versus hydrocortisone in the topical treatment of active ulcerative colitis: a randomized, double-blind study. Am J Gastroenterol 1995, 90:736-739. This experience confirms the equal efficacy of 1-g 5-ASA enemas and 100-mg hydrocortisone enemas in treating mild to moderate distal ulcerative colitis.
12. Marteau P, Halphen M: Étude comparative ouverte randomisée de l'efficacité et de la tolérance de lavements de 2g d'acide 4-aminosalicylique (4-ASA) et de 1g d'acide 5-aminosalicylique (5-ASA) dans les formes basses de rectocolite hémorragique. Gastroenterol Clin Biol 1995, 19:31-35. 5-Aminosalicylic acid and 4-ASA enemas are confirmed to be equally effective in distal ulcerative colitis. 4-ASA is therefore suggested as a valid alternative.
13. Marshall JK, Irvine EJ: Rectal aminosalicylate therapy for distal ulcerative colitis: a meta-analysis. Aliment Pharmacol Ther 1995, 9:293-300. Elegant and comprehensive meta-analysis supporting the value of 5-ASA topical treatment as a first-line approach for patients with active distal colitis.
14. Nyman-Pantelidis M, Nilsson A, Wagner ZG, Borga O: Pharmacokinetics and retrograde colonic spread of budesonide enemas in patients with distal ulcerative colitis. Aliment Pharmacol Ther 1994, 6:617-622.
15. Tarpila S, Turunen U, Seppäälä K, Aukee S, Pikkarainen P, Elomaa I, Karvonen AL, Kääriäinen I, Sipponen P, Toivanen E, Heikius B, Niemelä S, Nurmi H, Tunturi-Hihnala H, Burnham WR, Cowan RE, Hine KR, Persson T, Salde L: Budesonide enema in active haemorrhagic proctitis: a controlled trial against hydrocortisone foam enema. Aliment Pharmacol Ther 1994, 8:591-595.
16. Löfberg R, Thomsen OØ, Langholz E, Schiöler R, Danielsson Å, Suhr O, Graffner H, Påhlman L, Matzen P, Møller JF, Halvorsen L, Hovdenak N, Willen R, Persson T, Seidegård C: Budesonide versus prednisolone retention enemas in active distal ulcerative colitis. Aliment Pharmacol Ther 1994, 8:623-629.
17. Vernia P, Marcheggiano A, Caprilli R, Frieri G, Corrao G, Valpiani D, Di Paolo MC, Paoluzi P, Torsoli A: Short-chain fatty acid topical treatment in distal ulcerative colitis. Aliment Pharmacol Ther 1995, 9:309-313. This interesting study found clinical superiority of short-chain fatty acid enemas over placebo in patients with active distal colitis.
18. Sachar DB: Maintenance therapy in ulcerative colitis and Crohn's disease. J Clin Gastroenterol 1995, 20:117-122. This clinical review confirms the valuable role of aminosalicylates administered either orally or topically in reducing relapse rates in patients with ulcerative colitis.
19. Sutherland LR, May GR, Shatter EA: Sulfasalazine revisited: a metaanalysis of 5-sminosalicylic acid in the treatment of ulcerative colitis. Ann Intern Med 1993, 118:540-549.
20. Kruis W, Judmaier G, Kayasseh L, Stolte M, Theuer, Scheurlen C, Hentschel E, Kratochvil P: Double-blind dose-finding study of olsalazine versus sulphasalazine as maintenance therapy for ulcerative colitis. Eur J Gastroenterol Hepatol 1995, 7:391-396. Multicenter 6-month trial comparing three different doses of olsalazine (0.5 to 1.25 g and 2.0 g) and sulfalazine (2.0 g daily) as maintenance therapy for ulcerative colitis. No significant differences were observed among the treatment groups; better results were obtained in patients with extensive disease.
21. Nilsson Å, Danielsson Å, Löfberg R, Benno P, Bergman L, Fausa O, Florholmen J, Karvonen AL, Kildebo S, Kollberg B, Lindberg G, Lööf L, Stig R, Tanghj H: Olsalazine versus sulphasalazine for relapse prevention in ulcerative colitis: a multicenter study. Am J Gastroenterol 1995, 90:381-387. Multicenter study showing that olsalazine (1 g/d) and sulfasalazine (2 g/d) are equally effective in maintenance treatment of ulcerative colitis; tolerability of olsalazine was better than reported in previous studies.
22. Miner P, Stephen H, Robinson M, Schwartz J, Arora S, Pentasa UC Maintenance Study Group: Safety and efficacy of controlled-release mesalamine for maintenance of remission in ulcerative colitis. Dig Dis Sci 1995, 40:296-304. Twelve-month, double-blind, placebo-controlled trial showing significant superiority of oral mesalamine (4 g/d) compared with placebo in maintenance of remission of ulcerative colitis. Also confirms the safety of mesalamine.
23. Trallori G, Messori A, Scuffi C, Bardazzi G, Silvano R, d'Albasio G, Pacini F: 5-Aminosalicylic acid enemas to maintain remission in left-sided ulcerative colitis: a meta- and economic analysis. J Clin Gastroenterol 1995, 20:257-259. Useful meta- and economic analysis showing the equivalent therapeutic effect of rectal and oral 5-ASA in maintaining remission in left-sided ulcerative colitis. However, the per-patient per-month cost of 5-ASA enema treatment was slightly lower.
24. Thomas GAO, Rhodes J, Mani V, Williams GT, Newcombe RG, Russel AH, Feyerabend C: Transdermal nicotine as maintenance therapy for ulcerative colitis. N Engl J Med 1995, 332:988-992. Disappointing study showing that transdermal nicotine was no better than placebo in maintaining remission of ulcerative colitis; moreover, side effects were more frequent in the nicotine-treated patients.
25. Vernia P, Cittadini M, Caprilli R, Torsoli A: Topical treatment of refractory distal ulcerative colitis with 5-ASA and sodium butyrate. Dig Dis Sci 1995, 40:305-307. Interesting uncontrolled small study suggesting that a combined topical butyrate-5-ASA treatment is of benefit for patients with refractory distal ulcerative colitis.