Efficacy of oral vs. topical, or combined oral and topical 5-aminosalicylates, in Ulcerative Colitis: systematic review and meta-analysis.

[Lady Organic]

http://www.ncbi.nlm.nih.gov/pubmed/22108446


Abstract

OBJECTIVES:

Efficacy of 5-aminosalicylic acids (5-ASAs) in ulcerative colitis (UC) has been studied previously in meta-analyses. However, no recent meta-analysis has studied the relative efficacies of differing routes of administration.

METHODS:

MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (through May 2011). Eligible trials recruited adults with mildly to moderately active UC, or quiescent UC, and compared oral 5-ASAs with either topical 5-ASAs or a combination of oral and topical 5-ASAs. Dichotomous data were pooled to obtain relative risk (RR) of failure to achieve remission in active UC, and RR of relapse of disease activity in quiescent UC, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference.

RESULTS:

The search identified 3,061 citations, and 12 randomized controlled trials (RCTs) were eligible. Four compared topical with oral 5-ASAs in active UC remission, with an RR of no remission with topical 5-ASAs of 0.82 (95% CI=0.52-1.28). Four trials compared combined with oral 5-ASAs in active UC (RR of no remission=0.65; 95% CI=0.47-0.91; NNT=5). Three RCTs compared intermittent topical with oral 5-ASAs in preventing relapse of quiescent UC (RR=0.64; 95% CI=0.43-0.95; NNT=4), and two compared combined with oral 5-ASAs (RR of relapse=0.48; 95% CI=0.17-1.38).

CONCLUSIONS:

Combined 5-ASA therapy appeared superior to oral 5-ASAs for induction of remission of mildly to moderately active UC. Intermittent topical 5-ASAs appeared superior to oral 5-ASAs for preventing relapse of quiescent UC.


as Topical forms, I know suppositaries and enemas. Enemas would go higher than suppositaries in the left colon, as I once discussed with my current GI.so for disease which go above rectum, I'd suggest enemas, but thats just my opinion! i wish I had tried these at diagnosis, but my previous GI never mentionned this possibility and I only took the pill version, which was treatment failure. maybe the Topical version didnt exist back in 2001? I imagine compliance to enema treatment must be difficult in many patients, still its should be pushed and offered in regards to the above results..

 

[2thFairy]

Suppositories and, later on, enemas did make a substantial improvement for me. I was using them in conjunction with oral 5-ASA. I naturally resisted using enemas, but it did help my pain within a few days of starting them.

 

[FrozenGirl]

I tried enemas. Not for long mind you ( week and a half) but I couldn't do it. It was painful to do and prevented me from sleeping or doing anything in the discomfort. I was suppose to try and keep them for an hour+ but due to the above factors and lack of helping in my disease I gave up on them.

 

[Lady Organic]

thats too bad Frozen girl.

I have just started mesalamine 4 g enema last night. Yesterday I got my calprotectine result of 57 (low grey zone). This might mean my 50mg of purinethol is not enough (again) and that disease activity is at the very early stage, coming back after 4 months fallowing prednisone withdrawal. Enemas was my plan idea at the end of my flare to help maintain the remission along with this low dose purinethol. Gi agreed. I gave a trial to purinethol alone, because... we never know right, ....,!!! the beauty of calprotectine is that it appears to be very sensitive, so time reaction can be very fast, as opposed to the ''wait and see'' approach which has too often led me to major flares... so yeah, im ready for those enemas because next option would be the big jump to Biologics, since I cant increase purinethol to 75 mg.

I am very happy i had no trouble using the enema and I had no trouble to keep it inside for the full night.

Frozen girl: when you used it , was your disease very active? if that was the case, this may have been the cause of enema discomfort and urgent expulsion, just my thought. I remember now using the suppositaries for just a few nights once when my disease was very active. and when the disease is very active, it is true its not interesting as our colon wants to expulsate everything very fast..

it may therefore be best to bring the disease to a certain level of mild activity before using enemas.

 

[FrozenGirl]

It was. It was only a couple months after diagnosis and I was only on med and Mezavant. Now it might help but I am hopefully my current med combo will be enough.