Is Apriso (Mesalamine) an Immunosuppressant?
No, Apriso (mesalamine) is not an immunosuppressant medication. It is classified as an aminosalicylate that works locally in the intestine to reduce inflammation without causing systemic immunosuppression 1.
Classification of Mesalamine (Apriso)
- Mesalamine is a locally acting anti-inflammatory agent that is widely used to maintain and induce remission in inflammatory bowel disease, particularly ulcerative colitis 2
- According to guidelines on immunosuppression in inflammatory bowel disease, aminosalicylates including mesalamine are specifically categorized as having "No systemic effects" regarding immunosuppression 1
- In the simplified degree of immunosuppression classification used to determine if live vaccines can be administered safely, aminosalicylates are placed in the "No" immunosuppression category 1
Mechanism of Action
- Mesalamine works primarily by targeting the inflammatory response locally in the intestine 3
- It reduces prostaglandin and leukotriene synthesis in the intestinal mucosa 3, 4
- Unlike immunosuppressants, mesalamine does not cause systemic immune inhibition or increase susceptibility to opportunistic infections 1
Comparison to True Immunosuppressants
True immunosuppressants used in IBD include:
- Thiopurines (azathioprine, 6-mercaptopurine) - associated with viral infections 1
- Methotrexate - considered moderate-severe immunosuppression at doses >20mg per week 1
- Anti-TNF agents (infliximab, adalimumab) - associated with fungal and mycobacterial infections 1
- Corticosteroids - associated with increased rates of fungal infections 1
Clinical Implications
- Patients taking mesalamine do not require the same infection prevention strategies as those on immunosuppressants 1
- Live vaccines are not contraindicated in patients taking mesalamine alone 1
- Mesalamine is considered safe during pregnancy, unlike many immunosuppressants 5, 4
Apriso Formulation Specifics
- Apriso is a specific formulation of mesalamine that contains granules of a mesalamine-polymer matrix coated with a pH-sensitive resin 6
- Each Apriso capsule contains 0.375g of mesalamine that begins releasing once the pH is greater than 6 in the ileum and colon 6
- It is FDA-approved for maintenance of remission in mild to moderate ulcerative colitis at a dose of 1.5g/day (four 375mg capsules once daily) 1, 6
Common Misconceptions
- Despite being used to treat inflammatory conditions, mesalamine should not be confused with immunomodulators or immunosuppressants 1
- While some medications for IBD significantly increase infection risk, mesalamine does not have this effect 1
While mesalamine can occasionally cause serious side effects like pneumonitis or cardiomyopathy, these are not related to immunosuppression but rather to idiosyncratic reactions 3, 4.