Effect of extended MMX mesalamine therapy for acute, mild-to-moderate ulcerative colitis.

Michael A Kamm, Gary R Lichtenstein, William J Sandborn, Stefan Schreiber, Kirstin Lees, Karen Barrett, Raymond Joseph
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Inflammatory bowel diseases
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Many patients with ulcerative colitis (UC) respond to mesalamine therapy within 8 weeks. Those not achieving remission after 8 weeks are often treated with steroids or other immunosuppressive therapies. This study aimed to determine the effect of 8 weeks'' high-dose MMX mesalamine extension therapy in patients with active, mild-to-moderate UC who had previously failed to achieve complete remission in 2 phase III, double-blind, placebo-controlled studies of MMX mesalamine (SPD476-301 and -302).Patients with active, mild-to-moderate UC who did not achieve clinical and endoscopic remission after <or=8 weeks'' treatment with MMX mesalamine (2.4 or 4.8 g/day), ASACOL (mesalamine) delayed-release tablets 2.4 g/day, or placebo in the phase III studies received MMX mesalamine 4.8 g/day for 8 weeks. The aim was to assess remission at week 8, defined as a total modified UC Disease Activity Index score of <or=1, calculated as: scores of 0 for rectal bleeding and stool frequency, a combined Physician''s Global Assessment score and sigmoidoscopy score of <or=1, no mucosal friability, and a >or=1 point reduction from baseline in sigmoidoscopy score.Results: Overall, 304 patients who entered this acute extension study were evaluated; 59.5% achieved remission at week 8. Remission rates were similar irrespective of prior treatment in the initial acute phase III studies.Most patients with mild-to-moderate UC who fail to achieve remission with up to 8 weeks'' initial mesalamine therapy can achieve clinical and endoscopic remission following a further 8 weeks'' treatment with high-dose MMX mesalamine therapy, thereby avoiding step-up therapy.