Use of old and new oral 5-aminosalicylic acid formulations in inflammatory bowel disease
Donald G. Vidt, MD
Aaron Brzezinski, MDAddress reprint requests to A.B., Department of Gastroenterology, S40, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
George B. Rankin, MD
Douglas L. Seidner, MD
Bret A. Lashner, MD, MPH
Although sulfasalazine, a 5-aminosalicylic acid (5-ASA) agent, is still the anti-inflammatory agent of choice for ulcerative colitis and Crohn's disease, newer formulations, which release drug to specific regions of the colon for maximal efficacy, also can be appropriate first-line agents. This article reviews recent clinical studies of therapy with older and newer 5-ASA formulations.KEY POINTS
For patients with mildly to moderately active ulcerative colitis or mild Crohn's ileitis, ileocolitis, or colitis who are not allergic to sulfa drugs, sulfasalazine is the drug of choice. Olasalazine is similar in effectiveness to sulfasalazine, and is useful in treating patients allergic to or intolerant of sulfasalazine. The pH-sensitive preparations of mesalamine are useful, although none is more effective than sulfasalazine in patients with mildly to moderately active ulcerative colitis or in maintenance of remission.
Ethylcellulose-coated mesalamine delivers active drug to the proximal small intestine. Even though not approved for Crohn's disease, this formulation may be worthwhile before using steroids because it has fewer adverse effects.