From the Guidelines
Treatment failure of oral Mesalamine (Mesalazine) for ulcerative colitis is indicated by lack of clinical remission or improvement in symptoms despite optimized therapy.
- The American Gastroenterological Association (AGA) recommends using either standard dose mesalamine (2–3 grams/d) or diazo-bonded 5-ASA for induction and maintenance of remission in patients with extensive mild-moderate ulcerative colitis 1.
- Patients who do not respond to standard-dose mesalamine or diazo-bonded 5-ASA may be considered for high-dose mesalamine (>3gm/d) or addition of rectal mesalamine 1.
- The British Society of Gastroenterology consensus guidelines suggest that patients with moderately active UC may have a better response to 4.8 g/day of mesalazine than 2.4 g/day 1.
- Lack of response to optimized 5-ASA therapy, including oral and rectal mesalamine, may indicate treatment failure and require escalation to corticosteroids or other therapies 1.
- The AGA suggests using rectal corticosteroid therapy in patients with ulcerative proctitis who are refractory to or intolerant of mesalamine suppositories 1.
- Patients who require repeated or prolonged corticosteroid courses should be considered for escalation to biologic therapies and/or immunomodulators 1.
From the Research
Indicators of Treatment Failure
The following indicators suggest treatment failure of oral Mesalamine (Mesalazine) for ulcerative colitis:
- Lack of efficacy, as reported by 20.6% of patients in a study 2
- Four or more bowel movements per day, which was associated with discontinuation of enema application in a study 2
- Lower scores on measurement of the doctor-patient relationship, which was also associated with discontinuation of enema application 2
- Failure to achieve clinical improvement in stool frequency and/or rectal bleeding, as seen in 34% of patients in a study 3
- Failure to achieve endoscopic improvement, as seen in 52% of patients in a study 3
Factors Influencing Treatment Outcome
Several factors can influence the outcome of oral Mesalamine treatment for ulcerative colitis, including:
- Dose of Mesalamine: higher doses may be more effective, as suggested by a study 3 where increasing the dose to 4.0g/day led to clinical improvement in 66% of patients
- Patient adherence: maintaining patient adherence is crucial for effective treatment, as noted in a review 4
- Disease severity: patients with mild active ulcerative colitis may respond equally well to oral Mesalamine as those receiving combined oral and topical treatment, as found in a study 5
- Disease extent: patients with left-sided or distal disease may require higher daily doses of oral Mesalamine or supplementation with rectal Mesalazine, as suggested by a review 6