A meta-analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis

• Published in: The American journal of gastroenterology Vol. 95; no. 5; pp. 1263 - 1276
• Main Authors: Cohen, Russell D, Woseth, Douglas M, Thisted, Ronald A, Hanauer, Stephen B
• Format: Journal Article
• Language: English
• Published: Oxford . 01-05-2000; Blackwell Publishing; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Colitis, Ulcerative - drug therapy; Digestive system; Gastroenterology; Glucocorticoids - therapeutic use; Humans; Medical sciences; Mesalamine - adverse effects; Mesalamine - therapeutic use; Pharmacology. Drug treatments; Proctitis - drug therapy; Remission Induction; Human; Controlled therapeutic trial; Review; Inflammatory disease; Metaanalysis; Chemotherapy; Randomization; Proctitis; Treatment; Digestive diseases; Intestinal disease; Decision criterion; Left colon; Anorectal disease; Bibliographic review; Ulcerative colitis
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2000.01940.x

Therapeutic trials in left-sided ulcerative colitis (L-UC) and ulcerative proctitis (UP) have lacked control for medication type, dose, delivery, and duration of therapy. All published therapeutic articles and abstracts in L-UC or UP from1958–1997 were reviewed. Improvement, remission rates, and adverse events were recorded for all (ALL), placebo-controlled (PC) studies, and for PC studies passing quality assessment (QA) scoring. Meta-analysis was used where appropriate. Left-sided UCFor active disease, 67 studies (17 PC; 10 QA) were identified. Mesalamine enemas achieved remission in a duration but not a dose response (QA), with higher remission rates than steroid enemas (ALL) and clinical improvement rates superior to oral therapies (QA, ALL). Remission maintenance17 (six PC, six QA) studies were identified. Mesalamine therapies had comparable remission rates at 6 months, with a possible dose but not delivery effect. Mesalamine enema dosing intervals between QHS to Q3 days maintained efficacy. Reported adverse events were most common with oral sulfasalazine and dose-independent for mesalamine. Withdrawals from therapy were less than placebo, or ≤3%. Ulcerative proctitisFor active disease, 18 (nine PC, three QA) studies were identified. Mesalamine suppositories achieved clinical improvement and remission in a duration but not dose response, with higher rates of remission than topical steroids (ALL). Remission maintenancethree (three PC, two QA) studies were identified. Remission ranged from 75% to 90% (6 months) and 61–90% (12 months) for mesalamine agents. Reported adverse events were most common for mesalamine foam (8%). Withdrawals from therapy were <2%. In L-UC and UP, the efficacy and side-effect profile of topical mesalamine are dose independent and superior to oral therapies and topical steroids. Economic analysis suggests that use of these agents will also result in an overall decrease in patient costs.