Review
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 14, 2006; 12(38): 6115-6123
Published online Oct 14, 2006. doi: 10.3748/wjg.v12.i38.6115
Indications for 5-aminosalicylate in inflammatory bowel disease: Is the body of evidence complete?
Ad A van Bodegraven, Chris JJ Mulder
Ad A van Bodegraven, Section of Inflammatory Bowel Diseases, VU University medical centre, Amsterdam, The Netherlands
Chris JJ Mulder, Department of Gastroenterology, VU University medical centre, Amsterdam, The Netherlands
Supported by research grants from Astrazeneca (Zoetermeer, The Netherlands), Ferring BV (Hoofddorp, The Netherlands), P and G Pharmaceuticals (Cincinnati, United States), ALTANA Pharma BV (Hoofddorp, The Netherlands), and Tramedico BV (Weesp, The Netherlands), Falk Company (Freiburg, Germany), and Ferring International (Copenhagen, Denmark)
Correspondence to: Ad van Bodegraven, Department of Gastroenterology, VU University medical centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands. v.bodegraven@vumc.nl
Telephone: +31-20-4440613 Fax: +31-20-4440554
Received: November 8, 2005
Revised: November 28, 2005
Accepted: February 20, 2006
Published online: October 14, 2006
Abstract

Mesalazine is a safe drug, although adverse events may be seen in a minority of patients. This applies also to pregnant women and children. The role of mesalazine in combination therapy to improve efficacy and concomitant drug pharmacokinetics, or in chemoprevention against inflammatory bowel disease (IBD)-related colonic carcinoma has not yet been completely elucidated. Therapeutic success of mesalazine may be optimized by a combination of high dose and low frequency of dosage to improve compliance. Therefore, due to its superior safety profile and pharmacokinetic characteristics, mesalazine is preferable to sulphasalazine. This paper reviews the literature concerning mechanisms of action, indications and off-label use, pharmacokinetic properties and formulations, therapeutic efficacy, compliance, paediatric indications, chemoprevention, and safety issues and adverse event profile of mesalazine treatment versus sulphasalazine. It also highlights these controversies in order to clarify the potential benefits of mesalazines in IBD therapy and evidence for its use.

Keywords: Mesalazine, Sulphasalazine, Review, Ulcerative colitis, Crohn’s disease, Treatment, Chemoprevention, Pregnancy, Adverse events