From the Guidelines
The treatment for mild to moderate ulcerative colitis (UC) typically begins with oral mesalamine (2-3 grams/d) or diazo-bonded 5-ASA, as recommended by the AGA Clinical Guidelines Committee 1.
Key Recommendations
- For patients with extensive mild-moderate ulcerative colitis, the AGA recommends using either standard dose mesalamine (2–3 grams/d) or diazo-bonded 5-ASA rather than low dose mesalamine, sulfasalazine or no treatment 1.
- In patients with mild-moderate ulcerative colitis with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, the AGA suggests using high-dose mesalamine (>3gm/d) with rectal mesalamine 1.
- For patients with left-sided mild-moderate ulcerative proctosigmoiditis or proctitis, the AGA suggests using mesalamine enemas (or suppositories) rather than oral mesalamine 1.
Treatment Approach
The treatment approach for mild to moderate UC involves the use of 5-aminosalicylates (5-ASAs) such as mesalamine, which work by reducing inflammation in the intestinal mucosa. The choice of treatment depends on the extent and severity of the disease, as well as the patient's response to initial therapy.
Additional Considerations
- Regular monitoring of disease activity through clinical assessment, laboratory tests, and occasionally endoscopy is essential to adjust treatment 1.
- Dietary modifications can help manage symptoms, with low-residue diets during flares and adequate nutrition being important.
- Immunomodulators like azathioprine or 6-mercaptopurine may be added as steroid-sparing agents in patients with moderate to severe disease.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Mild to Moderate Ulcerative Colitis (UC) and Crohn's Disease (CD)
- Mesalamine is the first-line drug for mild to moderate ulcerative colitis (UC) 2, 3, 4
- Mesalamine has been demonstrated to induce and maintain remission in UC patients, with few serious adverse effects and is generally well tolerated by patients 2, 4
- Once daily (OD) dosing of mesalamine is as effective and safe as multiple daily (MD) doses for the induction and maintenance treatment of mild to moderate UC 2
- MMX mesalamine, an oral, high-strength, once-daily formulation of 5-ASA, has been shown to be effective in inducing and maintaining clinical and endoscopic remission in active mild-to-moderate UC 3
Treatment for Crohn's Disease (CD)
- High-dose mesalamine may be an option for inducing remission in mild-to-moderate Crohn's disease, especially among patients preferring to avoid steroids 5, 6
- Corticosteroids and high-dose budesonide are effective treatments for inducing remission in mild-to-moderate Crohn's disease 5, 6
- Sulfasalazine was not significantly superior to any therapy, including placebo, for inducing remission in mild-to-moderate Crohn's disease 5, 6