From the Guidelines
Hematochezia typically resolves within 2-8 weeks after starting mesalamine for ulcerative colitis.
Resolution Time
- The resolution time for hematochezia can vary depending on the dose of mesalamine and the individual patient's response to treatment.
- Studies have shown that 4.8 g/day of mesalamine is associated with more rapid symptom resolution than 2.4 g/day 1.
- Specifically, 10-30% of patients are in symptomatic remission at week 2,30-45% by week 4, and 35-50% by week 8 after starting mesalamine 1.
Dose and Response
- The ASCEND III trial found that patients with moderately active UC had a better response to 4.8 g/day of mesalamine than 2.4 g/day (72% vs 59%, p=0.036) 1.
- Subgroup analysis showed that patients who had received steroid, oral 5-ASA, and rectal therapies were more likely to respond to the higher dose of 4.8 g/day 1.
Mucosal Healing
- The 5-ASA MMX trials also showed that 4.8 g/day was more effective than 2.4 g/day in the subpopulation with prior exposure to 5-ASA, and in those who had an incomplete response to 8 weeks of 5-ASA MMX at 2.4 g/day 1.
- A post-hoc analysis of the ASCEND I and II data also showed that there was greater mucosal healing in the 4.8 g/day group compared with 2.4 g/day 1.
From the Research
Resolution Time for Hematochezia after Starting Mesalamine
- The resolution time for hematochezia after starting mesalamine for ulcerative colitis is not explicitly stated in the provided studies.
- However, study 2 reports that 59 patients (66%) achieved clinical improvement in stool frequency and/or rectal bleeding, including 40 (44%) with clinical remission, after 8 weeks of treatment with oral mesalazine at 4.0g/day.
- Study 3 found that combined oral and rectal mesalazine treatment achieved a significantly higher rate of improvement in symptoms, including cessation of rectal bleeding, within 2 weeks, compared with oral-only treatment.
- The study 3 also reported that bleeding ceased significantly more quickly with combination vs. oral therapy (p = 0.003), with most patients achieving cessation of bleeding within 4 weeks.
Factors Affecting Resolution Time
- The dose of mesalazine may affect the resolution time, with higher doses tend to be more effective 4, 5.
- The formulation of mesalazine, such as prolonged-release or combined oral and rectal, may also impact the resolution time 4, 3.
- The severity of symptoms and the extent of disease may also influence the resolution time, with milder cases potentially responding more quickly to treatment 5, 3.