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van de Meeberg MM, Verheij ER, Fidder HH, Bouma G, Huitema ADR, Oldenburg B. Potential of Mesalazine Therapeutic Drug Monitoring by Measuring Fecal Excretion in Patients With Ulcerative Colitis. Ther Drug Monit 2023; 45:668-675. [PMID: 36823707 DOI: 10.1097/ftd.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Therapeutic drug monitoring of mesalazine (5-ASA) in patients with ulcerative colitis is unavailable. Mucosal 5-ASA concentrations are assumed to be higher during remission, but biopsy is not practical. Therefore, we investigated the feasibility of measuring mesalazine levels in feces. To explore the potential role of fecal mesalazine measurements in therapeutic drug monitoring, we compared the dry fecal concentration and daily fecal excretion of 5-ASA and its metabolite N-acetyl-5-ASA in patients with ulcerative colitis with active and quiescent disease. METHODS Adults with ulcerative colitis on oral mesalazine and scheduled for colonoscopy were eligible for inclusion in this cross-sectional study. Stool and urine samples were collected for 48 and 24 hours, respectively, and rectal biopsies were performed. (N-acetyl-)5-ASA was measured using mass spectrometry. Biochemically active disease was defined as a fecal calprotectin level above 100 mcg/g and endoscopically active disease as any activity following the endoscopic Mayo score (≥1). RESULTS Approximately 28 patients were included in the study. Daily fecal excretion of (N-acetyl-)5-ASA did not differ between patients with (n = 13) and without (n = 15) endoscopically active disease [median 572 mg/d versus 597 mg/d ( P = 0.86) for 5-ASA and 572 mg/d versus 554 mg/d ( P = 0.86) for N-acetyl-5-ASA]. The same applied to the fecal concentration [median 9.7 mcg/mg dry weight versus 10.3 ( P = 0.53) and 12.0 versus 9.9 ( P = 0.89)]. The results were comparable when the biochemical disease activity definition was used. The mucosal concentrations and urinary excretion of (N-acetyl-)5-ASA did not differentiate between quiescent and active activity. CONCLUSIONS Fecal (N-acetyl-)5-ASA measurements do not correlate with disease activity, which renders it an unsuitable tool for therapeutic drug monitoring of mesalazine.
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Affiliation(s)
- Maartje M van de Meeberg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam
| | | | - Herma H Fidder
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam ; and
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht
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Ikuta S, Nakagawa H, Kai T, Sugano K. Development of bicarbonate buffer flow-through cell dissolution test and its application in prediction of in vivo performance of colon targeting tablets. Eur J Pharm Sci 2023; 180:106326. [PMID: 36347443 DOI: 10.1016/j.ejps.2022.106326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to develop a bicarbonate buffer flow-through cell (FTC) dissolution test. Mesalazine colon targeting tablets of a generic development product (test formulation, TF; Mesalazine 400 mg tablet) and the original product (reference formulation, RF; Asacol® 400 mg tablet) were used as model formulations. A clinical bioequivalence (BE) study was conducted on 48 healthy male subjects under fasting conditions. The oral absorption time profiles were calculated by point-area deconvolution. The compendial paddle and FTC apparatus were used for dissolution tests. Bicarbonate or phosphate-citrate buffer solutions (McIlvaine buffer) were used as the dissolution media. A floating lid was used to maintain the pH value of the bicarbonate buffer solution in the vessel (paddle) or the reservoir (FTC). In the development of bicarbonate FTC method, the pH changes of bicarbonate buffer solution (pH 5.5-7.5; 5-50 mM bicarbonate) were evaluated. For the evaluation of colon targeting tablets, the dissolution profiles of TF and RF were measured at a pH of 7.5. The TF and RF formulations were exposed to 0.01 HCl (pH 2.0) for 2 h before pH 7.5. In the clinical BE study, drug dissolution started 4-8 h after oral administration and continued slowly more than 10 h. Both the area under the curve (AUC) and maximum plasma concentration (Cmax) of TF were approximately twice as high as those of RF. In the development of the bicarbonate FTC method, the pH change of the bicarbonate buffer solution was suppressed by the floating lid within ∆pH < 0.1 over 10 h. In the dissolution test of McIlvaine buffer solutions, TF and RF showed faster disintegration and higher dissolution than those observed in the clinical BE study. When using the paddle apparatus the dissolution profiles of TF and RF in both buffer solutions were not consistent with those of the clinical result. In bicarbonate FTC, the disintegration time, dissolution rate, and dissolution inequivalence between TF and RF were consistent with the results of the clinical BE study. In conclusion, the bicarbonate FTC method was constructed for the first time in this study. This method is simple and practically useful for predicting in vivo performance of colon targeting tablets during drug development.
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Affiliation(s)
- Shotaro Ikuta
- Molecular Pharmaceutics Lab., College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga 525-8577, Japan; Pharmaceutical Research Laboratories, Pharmaceutical Department, Nipro corporation, 3023, Noji-Cho, Kusatsu, Shiga 525-0055, Japan.
| | - Hidetoshi Nakagawa
- Pharmaceutical Research Laboratories, Pharmaceutical Department, Nipro corporation, 3023, Noji-Cho, Kusatsu, Shiga 525-0055, Japan
| | - Toshiya Kai
- Pharmaceutical Research Laboratories, Pharmaceutical Department, Nipro corporation, 3023, Noji-Cho, Kusatsu, Shiga 525-0055, Japan
| | - Kiyohiko Sugano
- Molecular Pharmaceutics Lab., College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
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3
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Zhang Y, Wo SK, Leng W, Gao F, Yan X, Zuo Z. Population pharmacokinetics and IVIVC for mesalazine enteric-coated tablets. J Control Release 2022; 346:275-288. [PMID: 35461968 DOI: 10.1016/j.jconrel.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/17/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
Although in-vivo bioequivalence (BE) study serves as a golden standard for establishing interchangeability of oral dosage forms, it remains challenging for products with high inter-subject variability such as mesalazine enteric-coated tablet to fulfil the BE criteria set by regulatory authorities. Mesalazine, as a BCS class IV drug, targets to be delivered to distal ileum or colon with a pH-sensitive polymer coating for the remission of ulcerative colitis. Through population pharmacokinetic (PK) analysis and in-vitro in-vivo correlation (IVIVC) modeling on the dissolution and BE data of a generic enteric-coated product (EM) and its reference Salofalk® 250 mg tablet (SM), we for the first time revealed the underlying mechanism of the high inter-subject variability for such delayed-release formulation. It was also noted that the in-vivo start time of absorption (Ts) for EM and SM was positively correlated with their in-vitro lag time (Tlag) under the USP three-stage dissolution condition and reversely correlated with their in-vivo bioavailability. The varied oral bioavailability of mesalazine enteric-coated tablet was mainly due to the varied N-acetyltransferase activities along GI tract. Although such extensive intestinal first-pass metabolism with large individual differences led to a significant variation of mesalazine Cmax (coefficient of variation: 60-63.5%) and AUC0-t (coefficient of variation: 37.5-46.9%), the corresponding variations in the total absorbed mesalazine (mesalazine and its metabolite N-acetyl mesalazine) were significantly reduced by 12 to 45%. Since the BE purpose for mesalazine enteric-coated tablet focused on their comparable safety profiles, total absorbed mesalazine was recommended to be adopted for the development of the IVIVC model and BE evaluation for EM. All in all, our model-based approach has not only successfully identified the key factors that affect the BE of EM to guide its further formulation optimization, but also demonstrated the indispensable role of modeling in the development of generic pharmaceutical product at its early stages.
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Affiliation(s)
- Yufeng Zhang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Siu Kwan Wo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Wei Leng
- Europharm Laboratoires Co. Ltd., 12-14 Dai Wang Street, Tai Po Industrial Estate, Tai Po, New Territories, Hong Kong Special Administrative Region
| | - Fang Gao
- Europharm Laboratoires Co. Ltd., 12-14 Dai Wang Street, Tai Po Industrial Estate, Tai Po, New Territories, Hong Kong Special Administrative Region
| | - Xiaoyu Yan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Zhong Zuo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region.
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Sakamoto A, Izutsu KI, Yoshida H, Abe Y, Inoue D, Sugano K. Simple bicarbonate buffer system for dissolution testing: Floating lid method and its application to colonic drug delivery system. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sagmeister P, Poms J, Williams JD, Kappe CO. Multivariate analysis of inline benchtop NMR data enables rapid optimization of a complex nitration in flow. REACT CHEM ENG 2020. [DOI: 10.1039/d0re00048e] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Multivariate analysis is applied to inline benchtop NMR data for a complex nitration in flow. This rapid quantification enables reaction optimization using advanced techniques in flow, such as design of experiments and dynamic experimentation.
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Affiliation(s)
- Peter Sagmeister
- Center for Continuous Flow Synthesis and Processing (CCFLOW)
- Research Center Pharmaceutical Engineering (RCPE)
- 8010 Graz
- Austria
- Institute of Chemistry
| | - Johannes Poms
- Research Center Pharmaceutical Engineering (RCPE)
- 8010 Graz
- Austria
| | - Jason D. Williams
- Center for Continuous Flow Synthesis and Processing (CCFLOW)
- Research Center Pharmaceutical Engineering (RCPE)
- 8010 Graz
- Austria
- Institute of Chemistry
| | - C. Oliver Kappe
- Center for Continuous Flow Synthesis and Processing (CCFLOW)
- Research Center Pharmaceutical Engineering (RCPE)
- 8010 Graz
- Austria
- Institute of Chemistry
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6
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Zhang SH, Li Y, Wei SS, Guo L, Huang XM, Chen Y, Wu XX, Cai HL, Zhang BK. Effects of Differential Food Patterns on the Pharmacokinetics of Enteric-Coated Mesalazine Tablets in the Same Cohort of Healthy Chinese Volunteers. Clin Pharmacol Drug Dev 2019; 9:41-49. [PMID: 31056855 DOI: 10.1002/cpdd.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/15/2019] [Indexed: 11/11/2022]
Abstract
This study aimed to simultaneously determine mesalazine (5-ASA) and its major metabolite N-Ac-5-ASA in the plasma and to evaluate the impact of different food patterns on the relative bioavailability and pharmacokinetics of a single oral dose of 5-ASA in healthy subjects. In this single-dose, open-label, 3-period, 3-treatment crossover study, the subjects received a single, oral dose of 500-mg enteric-coated mesalazine tablet together with either a low-fat or a high-fat breakfast or under fasting condition (reference). The pharmacokinetic parameters were determined by noncompartmental methods and analyzed with a linear mixed-effect model. The geometric least squares mean ratio for the area under the plasma concentration-time curve from zero to infinity of N-Ac-5-ASA was 1.05 (90% confidence interval [CI], 0.70-1.58) for high-fat/fasted condition and 1.06 (90%CI, 0.82-1.36) for low-fat/fasted condition. The least squares mean ratio of 5-ASA was 0.86 (90%CI, 0.65-1.14) for high-fat/fasted condition and 0.78 (90%CI, 0.60-1.02) for low-fat/fasted condition. All P values were >.05. The mean maximum plasma concentration and the time to reach the maximum plasma concentration of N-Ac-5-ASA were 2084 ng/mL, 8 hours; 2639 ng/mL, 11 hours, and 2409 ng/mL, 9 hours for fasted, high-fat, and low-fat, respectively. The values of 5-ASA were 1950 ng/mL, 7 hours; 2869 ng/mL, 9 hours; and 2837 ng/mL, 8 hours for fasted, high-fat, and low-fat condition. 5-ASA was well tolerated under all 3 conditions. Food delayed the absorption of 5-ASA, especially a high-fat meal. Therefore, enteric-coated mesalazine tablets should be taken before meals to avoid causing patients slow response and any effect of food on its efficacy.
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Affiliation(s)
- Su-Hua Zhang
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Yao Li
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Shan-Shan Wei
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Lin Guo
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xiao-Mei Huang
- Department of National Drug Clinical Trial Research Center, Xiangyya BoAi Rehabilitation Hospital, Changsha, China
| | - Ying Chen
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Xiang-Xin Wu
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hua-Lin Cai
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Bi-Kui Zhang
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,School of Pharmaceutical Sciences, Central South University, Changsha, China
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7
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Karkossa F, Klein S. A Biopredictive In Vitro Comparison of Oral Locally Acting Mesalazine Formulations by a Novel Dissolution Model for Assessing Intraluminal Drug Release in Individual Subjects. J Pharm Sci 2018; 107:1680-1689. [DOI: 10.1016/j.xphs.2018.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 01/07/2023]
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8
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Sferrazza G, Siviero PD, Nicotera G, Turella P, Serafino A, Blandizzi C, Pierimarchi P. Regulatory framework on bioequivalence criteria for locally acting gastrointestinal drugs: the case for oral modified release mesalamine formulations. Expert Rev Clin Pharmacol 2017; 10:1007-1019. [PMID: 28656793 DOI: 10.1080/17512433.2017.1348227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Bioequivalence testing for locally acting gastrointestinal drugs is a challenging issue for both regulatory authorities and pharmaceutical industries. The international regulatory framework has been characterized by the lack of specific bioequivalence tests that has generated a negative impact on the market competition and drug use in clinical practice. Areas covered: This review article provides an overview of the European Union and United States regulatory frameworks on bioequivalence criteria for locally acting gastrointestinal drugs, also discussing the most prominent scientific issues and advances that has been made in this field. A focus on oral modified release mesalamine formulations will be also provided, with practical examples of the regulatory pathways followed by pharmaceutical companies to determine bioequivalence. Expert commentary: The development of a scientific rationale to demonstrate bioequivalence in this field has been complex and often associated with uncertainties related to scientific and regulatory aspects. Only in recent years, thanks to advanced knowledge in this field, the criteria for bioequivalence assessment are undergoing substantial changes. This new scenario will likely result in a significant impact on pharmaceutical companies, promoting more competition through a clearer regulatory approach, conceived for streamlining the demonstration of therapeutic equivalence for locally acting gastrointestinal drugs.
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Affiliation(s)
- Gianluca Sferrazza
- a Institute of Translational Pharmacology , National Research Council , Rome , Italy
| | | | - Giuseppe Nicotera
- a Institute of Translational Pharmacology , National Research Council , Rome , Italy
| | - Paola Turella
- c Pharma Unit - pre-submission Analysis and Strategy , Intexo S.r.l. , Rome , Italy
| | - Annalucia Serafino
- a Institute of Translational Pharmacology , National Research Council , Rome , Italy
| | - Corrado Blandizzi
- d Department of clinical and Experimental Medicine, Unit of Pharmacology and Pharmacovigilance , University of Pisa , Pisa , Italy
| | - Pasquale Pierimarchi
- a Institute of Translational Pharmacology , National Research Council , Rome , Italy
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Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, d'Haens G, d'Hoore A, Mantzanaris G, Novacek G, Öresland T, Reinisch W, Sans M, Stange E, Vermeire S, Travis S, van Assche G. [Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management (Spanish version)]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 80:32-73. [PMID: 25769217 DOI: 10.1016/j.rgmx.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 02/06/2023]
Affiliation(s)
- A Dignass
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso.
| | | | - A Sturm
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - A Windsor
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - J-F Colombel
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - M Allez
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - G d'Haens
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - A d'Hoore
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - G Mantzanaris
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - G Novacek
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - T Öresland
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - W Reinisch
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - M Sans
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - E Stange
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - S Vermeire
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
| | - S Travis
- Contribuyeron por igual a este trabajo; Coordinadores del Consenso
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Böhm SK, Kruis W. Long-term efficacy and safety of once-daily mesalazine granules for the treatment of active ulcerative colitis. Clin Exp Gastroenterol 2014; 7:369-83. [PMID: 25285021 PMCID: PMC4181447 DOI: 10.2147/ceg.s35691] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In 1977, 5-aminosalicylic acid (5-ASA) was discovered as a therapeutically active moiety of sulfasalazine (SASP) and was launched for topical and oral therapy of ulcerative colitis (UC) in 1984. As a first-step, delivery systems had to be developed to protect 5-ASA against absorption in the upper gastrointestinal tract, resulting in different and competing strategies (azo compounds, controlled release, and pH-dependent release). In a second step, at the beginning of the new century, coinciding with the expiration of patent protection for the first 5-ASA formulations, two component composite release mechanisms (pH-dependent and controlled release) were developed. Furthermore, the drug was formulated as granules instead of tablets, allowing higher unit strengths compared with tablets. Neither Salofalk Granu-Stix®, nor MMX 5-ASA, nor Pentasa® granules have initially been developed for once-daily (OD) dosing. A review of the achievements of 20 years of 5-ASA development has demonstrated that 5-ASA has equal efficacy compared with SASP at best, that there are no measurable differences in efficacy between various 5-ASA preparations, and that in a group of patients tolerating SASP, adverse event profiles of SASP and 5-ASA did not differ significantly, with SASP being the far cheaper substance. Therefore, drug adherence came into focus as a new goal for improving UC therapy. Although adherence is a complex and multifactorial construct, a simple dosing schedule may contribute to higher drug adherence and better efficacy of treatment. Simultaneously, the US 5-ASA market, estimated to be worth US$1.4 billion, is expected to grow continuously. Naturally, this very competitive market is not only driven by scientific progress but also by commercial interests. Thus, patents for minor changes to the formulation may serve as protection against drug companies trying to launch generic versions. Randomized controlled trials performed on OD dosing in induction of remission have demonstrated that OD administration of 5-ASA is as effective as conventional dosing in mild to moderate active UC. The three 5-ASA products MMX, Salofalk®, and Pentasa® employed in those studies so far have not shown differences in efficacy between OD and conventional dosing. No differences regarding safety outcomes have been detected between OD and conventional dosing, including incidence of adverse events, serious adverse events, or withdrawal from treatment due to an adverse event. Although the majority of patients prefer OD dosing to conventional dosing, it was not possible to detect differences in adherence between OD and multiple dose regimens in the clinical trial setting. Well-designed and controlled large-scale community-based studies are necessary to further investigate and prove the point of improved long-term adherence and treatment efficacy in OD dosing.
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Affiliation(s)
- Stephan Karl Böhm
- Kantonsspital Baselland, Medizinische Universitätsklinik, Bruderholz, Switzerland
| | - Wolfgang Kruis
- Evangelisches Krankenhaus Kalk, University of Cologne, Cologne, Germany
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Bafutto M, Almeida JRD, Leite NV, Costa MBG, Oliveira ECD, Resende-Filho J. Treatment of diarrhea-predominant irritable bowel syndrome with mesalazine and/or Saccharomyces boulardii. ARQUIVOS DE GASTROENTEROLOGIA 2014; 50:304-9. [PMID: 24474234 DOI: 10.1590/s0004-28032013000400012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
Abstract
CONTEXT Irritable bowel syndrome (IBS) is a functional bowel disease characterized by abdominal pain and altered intestinal habits. The pathophysiology of IBS remains unclear. Recent studies have demonstrated that some IBS patients, especially in diarrhea-predominant IBS (IBS-D), display persistent signs of minor mucosal inflammation and a modified intestinal microflora. The mesalazine has known intestinal anti-inflammatory properties. Saccharomyces boulardii is a probiotic used for a long time in treatment of diarrhea, including infectious diarrhea. OBJECTIVE Evaluate the effects of mesalazine alone, combined therapy of mesalazine with liophylised Saccharomyces boulardii or alone on symptoms of IBS-D patients. METHODS Based on Rome III criteria, 53 IBS-D patients (18 year or more) were included. To exclude organic diseases all patients underwent colonoscopy, stool culture, serum anti-endomisium antibody, lactose tolerance test and ova and parasite exam. Patients were divided in three groups: mesalazine group (MG) - 20 patients received mesalazine 800 mg t.i.d. for 30 days; mesalazine and Saccharomyces boulardii group (MSbG) - 21 patients received mesalazine 800 mg t.i.d. and Saccharomyces boulardii 200 mg t.i.d. for 30 days and; Saccharomyces boulardii group (SbG) - 12 patients received Sb 200 mg t.i.d. for 30 days. Drugs that might have any effect on intestinal motility or secretion were not allowed. Symptom evaluations at baseline and after treatment were performed by means of a 4-point likert scale including: stool frequency, stool form and consistency (Bristol scale), abdominal pain and distension. Paired t test and Kruskal-Wallis test were used for statistical analyses. RESULTS Compared to baseline, there were statistically significant reduction of symptom score after 30 th day therapy in all three groups: MG (P<0.0001); MSbG (P<0.0001) and in SbG (P = 0.003). There were statistically significant differences in the symptom score at 30 th day therapy of the MG, MSbG and SbG groups (P = 0.03). There were no statistical differences between MSbG and MG symptom score at 30th day therapy (P = 0.9). CONCLUSIONS The use of mesalazine alone, Saccharomyces boulardii alone or combined treatment with mesalasine and Saccaromyces boulardii improved IBS-D symptoms. The improvement of the symptom score was greater with mesalazine alone or combined with Sb as compared with Sb treatment alone. These preliminary results suggest that mezalazine may be useful in treatment of IBS-d patients, and warrant further larger studies.
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Affiliation(s)
- Mauro Bafutto
- Instituto Goiano de Gastroenterologia, GoiâniaGO, Brasil
| | - José Roberto de Almeida
- Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal de Pernambuco (UFPE), RecifePE, Brasil
| | | | | | - Enio Chaves de Oliveira
- Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal de Pernambuco (UFPE), RecifePE, Brasil
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Debnath S, Kienle A, Kulkarni AA. Evaluation of Multipoint Dosing Strategy in a Miniaturized Tubular Reactor: Nitration of Salicylic Acid. Chem Eng Technol 2014. [DOI: 10.1002/ceat.201300427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Kemp K, Sephton M. Aligning oral mesalazine treatment to health service priorities: guidance for nurses. Frontline Gastroenterol 2014; 5:135-142. [PMID: 24683448 PMCID: PMC3963542 DOI: 10.1136/flgastro-2013-100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/20/2013] [Accepted: 08/24/2013] [Indexed: 02/04/2023] Open
Abstract
Oral mesalazine represents a crucial front-line agent for the treatment of active ulcerative colitis (UC) and the maintenance of remission. Clinical aspects of mesalazine therapy are guided by robust evidence-based guidelines, although there is a relative paucity of guidance examining the specific administrative and professional issues faced by inflammatory bowel disease (IBD) nurses. As IBD nurses frequently influence treatment decisions in UC, this article was written to provide a practical review of the key evidence and issues affecting mesalazine treatment. Therefore, it may act as an additional resource for IBD nurses, to enhance prescribing decisions. Using the UK's Quality, Innovation, Productivity and Prevention (QIPP) agenda as a framework, it considers clinical and health service priorities affecting treatment decisions. The quality of care perspective naturally focuses on efficacy; recent interest in specific aspects of efficacy, such as the speed of symptom resolution allows targeting of mesalazine treatment to individual needs. Furthermore, innovative adherence programmes build on the latest evidence to develop robust, integrated patient support approaches. In terms of productivity, nurse-led activities and more sophisticated management strategies may offer the best routes towards reducing the costs of care. Key opportunities for preventing ill health include improving adherence to maintenance therapy and achieving mucosal healing. The principles and approaches highlighted by the QIPP agenda emphasise that prescribing decisions for mesalazine in UC must take account of the full spectrum of clinical and health service needs, and cannot focus on any one element in isolation.
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Affiliation(s)
- Karen Kemp
- Department of Gastroenterology, Manchester Royal Infirmary and University of Manchester, Manchester, UK
| | - Mark Sephton
- Department of Gastroenterology, University Hospital of South Manchester, Manchester, UK
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D’Incà R, Paccagnella M, Cardin R, Pathak S, Baldo V, Giron MC, Sturniolo GC. 5-ASA colonic mucosal concentrations resulting from different pharmaceutical formulations in ulcerative colitis. World J Gastroenterol 2013; 19:5665-5670. [PMID: 24039359 PMCID: PMC3769903 DOI: 10.3748/wjg.v19.i34.5665] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the mucosal concentrations of 5-aminosalicylic acid (5-ASA) resulting from different pharmaceutical formulations and analyse the influence of inflammation on the mucosal concentrations.
METHODS: The study included 130 inflammatory bowel disease (IBD) patients receiving 5-ASA as pH-dependent-release formulations (73 patients), time-dependent-release formulations (11 patients), or pro-drugs (18 patients). In addition, 28 patients were receiving topical treatment (2-4 g/d) with pH-dependent-release formulations. Endoscopic biopsies were obtained from the sigmoid region during the colonoscopy. The 5-ASA concentrations (ng/mg) were measured in tissue homogenates using high-pressure liquid chromatography with electrochemical detection. The t test and Mann-Whitney test, when appropriate, were used for statistical analysis.
RESULTS: Patients receiving pH-dependent-release formulations showed significantly higher mucosal concentrations of 5-ASA (51.75 ± 5.72 ng/mg) compared with patients receiving pro-drugs (33.35 ± 5.78 ng/mg, P = 0.01) or time-dependent-release formulations (38.24 ± 5.53 ng/mg, P = 0.04). Patients with endoscopic remission had significantly higher mucosal concentrations of 5-ASA than patients with active disease (60.14 ± 7.95 ng/mg vs 35.66 ± 5.68 ng/mg, P = 0.02). Similar results were obtained when we compared patients with the histological appearance of remission and patients with active histological inflammation (67.53 ± 9.22 ng/mg vs 35.53 ± 5.63 ng/mg, P < 0.001). Significantly higher mucosal concentrations of 5-ASA were detected in patients treated with both oral and topical treatments in combination compared with patients who received oral treatment with pH-dependent-release formulations alone (72.33 ± 11.23 ng/mg vs 51.75 ± 5.72 ng/mg, P = 0.03).
CONCLUSION: IBD patients showed significant variability in mucosal 5-ASA concentrations depending on the type of formulation, and the highest mean concentration was achieved using pH-dependent-release formulations.
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Robinson A, Hankins M, Wiseman G, Jones M. Maintaining stable symptom control in inflammatory bowel disease: a retrospective analysis of adherence, medication switches and the risk of relapse. Aliment Pharmacol Ther 2013; 38:531-8. [PMID: 23834298 PMCID: PMC3840705 DOI: 10.1111/apt.12396] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 05/09/2013] [Accepted: 06/14/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Maintenance therapy with 5-aminosalicylic acid (5-ASA) is a key strategy for preventing relapse in many patients with inflammatory bowel disease (IBD). Factors which disrupt 5-ASA delivery, such as non-adherence and 5-ASA switches, may destabilise symptom control. AIM To investigate the impact of non-adherence and medication switches on stable symptom control in UK patients with IBD. METHODS A retrospective cohort study was conducted using a UK dispensing database. Adherence was analysed in randomised matched samples for each of the six leading oral mesalazine formulations, measured by medication possession ratio (MPR); MPR ≥80% was classified as adherent. Relationships among adherence, switch and relapse were analysed over 18 months in patients receiving continuous mesalazine therapy throughout a 6-month baseline period (primary subgroup analysis). Relapses of active ulcerative colitis were identified using a doubling of MPR as a proxy. RESULTS Only 39% of patients in the matched samples (n = 1200) were classed as adherent. No significant differences in adherence were observed among mesalazine formulations. In the primary subgroup analysis (n = 568), non-adherent patients had a significantly greater risk of relapse than adherent patients (RR = 1.44, 95% CI = 1.08-1.94; P = 0.014). Among adherent patients (n = 276), those who switched had a 3.5-fold greater risk of relapse than those who did not switch (95% CI = 1.16-10.62; P = 0.008). CONCLUSIONS Both non-adherence and mesalazine switches in adherent patients were associated with significant increases in the risk of relapse, suggesting that disruption of mesalazine maintenance therapy may destabilise symptom control. These findings provide evidence to advocate caution when considering mesalazine switches for stable patients.
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Affiliation(s)
- A Robinson
- Salford Royal NHS Foundation TrustSalford, UK,Correspondence to: Dr A. Robinson, Department of Gastroenterology, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK., E-mail:
| | - M Hankins
- Faculty of Health Sciences, University of SouthamptonSouthampton, UK
| | - G Wiseman
- Medical Affairs, Warner Chilcott UK LtdWeybridge, UK
| | - M Jones
- Health Informatics Research, Sciensus LtdBrighton, UK
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Healey CJ, O'Malley J. Pharmacy-led switches of 5-ASA: impact on secondary care. Frontline Gastroenterol 2013; 4:88-90. [PMID: 28839706 PMCID: PMC5369795 DOI: 10.1136/flgastro-2012-100210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/07/2012] [Accepted: 09/08/2012] [Indexed: 02/04/2023] Open
Affiliation(s)
- Chris J Healey
- Gastroenterology and Hepatology Services, Airedale General Hospital, Keighley, West Yorkshire, UK
| | - John O'Malley
- Department of Gastroenterology, Wirral University Hospital Trust, Wirral, UK
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17
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Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, D'Haens G, D'Hoore A, Mantzaris G, Novacek G, Oresland T, Reinisch W, Sans M, Stange E, Vermeire S, Travis S, Van Assche G. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis 2012; 6:991-1030. [PMID: 23040451 DOI: 10.1016/j.crohns.2012.09.002] [Citation(s) in RCA: 683] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Axel Dignass
- Department of Medicine 1, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt/Main, Germany.
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Aimone AM, Connolly B, Chaudhary S, Lugtu-Pe J, Martinuzzi F, Pencharz P, O'Connor DL. A combination of pH-sensitive caplet coatings may be an effective noninvasive strategy to deliver bioactive substances, nutrients, or their precursors to the colon. Appl Physiol Nutr Metab 2010; 34:893-900. [PMID: 19935851 DOI: 10.1139/h09-090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We hypothesize that bacterially synthesized nutrients in the large intestine may significantly influence the nutritional status of humans and, specifically, that of the colonocytes. In vivo research with human subjects in this area has been extremely limited because of the absence of a noninvasive means to quantitatively deliver test doses of nutrients, or their precursors, to the colon. The purpose of this study was to design and test the effectiveness of a pH-dependent coating in delivering intact placebo caplets to the large intestine. Barium sulphate caplet cores (19.1 mm x 9.7 mm) were coated with 2 different pH-dependent acrylic copolymer products, Eudragit L100 and S100, in either a 1:0 ratio (100% Eudragit L100) or 3:1 ratio (75% Eudragit L100 and 25% S100). The disintegration profile of each formulation was determined through in vitro testing, then caplets were sequentially administered to 10 healthy volunteers, and monitored in vivo via serial abdominal fluoroscopic images. Test caplets with the 3:1 coating formulation had a 40% higher colon-targeting specificity compared with the 1:0-coated caplets, and tended to begin disintegrating at a later time after administration (p = 0.09). The total time from administration to complete disintegration was also significantly longer for the 3:1-coated caplets (p = 0.003). These results suggest that barium sulphate caplets with a 3:1 acrylic copolymer coating formulation ratio (Eudragit L100 and S100) may be a suitable delivery system for quantifying the biosynthesis of nutrients in the human large intestine and measuring their absorption across the colonic epithelium.
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Affiliation(s)
- Ashley M Aimone
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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19
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Kalbasi RJ, Massah AR, Zamani F, Javaherian Naghash H. Fast and Efficient Nitration of Salicylic Acid and Some Other Aromatic Compounds over H3PO4/TiO2-ZrO2Using Nitric Acid. CHINESE J CHEM 2010. [DOI: 10.1002/cjoc.201090086] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Vadnerkar G, Dhaneshwar S. Design and development of latentiated strategy for delivery of mesalazine to colon. J Drug Deliv Sci Technol 2009. [DOI: 10.1016/s1773-2247(09)50067-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Travis SPL, Stange EF, Lémann M, Oresland T, Bemelman WA, Chowers Y, Colombel JF, D'Haens G, Ghosh S, Marteau P, Kruis W, Mortensen NJM, Penninckx F, Gassull M. European evidence-based Consensus on the management of ulcerative colitis: Current management. J Crohns Colitis 2008; 2:24-62. [PMID: 21172195 DOI: 10.1016/j.crohns.2007.11.002] [Citation(s) in RCA: 402] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 11/23/2007] [Indexed: 02/08/2023]
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22
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Steinhart AH, Forbes A, Mills EC, Rodgers-Gray BS, Travis SPL. Systematic review: the potential influence of mesalazine formulation on maintenance of remission in Crohn's disease. Aliment Pharmacol Ther 2007; 25:1389-99. [PMID: 17539978 DOI: 10.1111/j.1365-2036.2007.03324.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effectiveness of pH 6-/pH 7-dependent and controlled-release mesalazines in maintaining medically and surgically induced Crohn's disease remission. METHODS A systematic search identified 13 randomized controlled trials (RCTs). The rate of symptomatic relapse (Crohn's disease activity index >150, or an increase in baseline by at least 60-100 points) was extracted from each randomized controlled trial. Pooled odds ratios (OR), the number needed to treat (NNT), and percentage therapeutic benefit (absolute risk reduction) were calculated. RESULTS Treatment with pH 7-dependent mesalazine significantly reduced the risk of relapse in patients with either surgically [OR 0.28; 95% confidence interval (CI) 0.12-0.65; P = 0.0032] or medically induced remission (OR 0.38; 95% CI 0.17-0.85; P = 0.0113). However, treatment with controlled-release mesalazine and pH 6-dependent mesalazine failed to show any significant advantage over placebo. The NNT to maintain surgically or medically induced remission was lowest for pH 7-dependent mesalazine (NNT = 4 and 5, respectively; NNT = 15 and 16 for controlled-release mesalazine and NNT = 11 and 23 for pH 6-dependent mesalazine). Therapeutic benefit was highest for pH 7-dependent mesalazine (surgical = 30.6%, medical = 22.8%). This compared with 6.9% (surgical) and 6.4% (medical) for controlled-release mesalazine, and 9.8% and 4.4%, respectively, for pH 6-dependent mesalazine. CONCLUSION Further trials of pH 7-dependent mesalazine formulations are warranted in the maintenance of remission in Crohn's disease.
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Affiliation(s)
- A H Steinhart
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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23
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Andreozzi R, Canterino M, Caprio V, Di Somma I, Sanchirico R. Batch salicylic acid nitration by nitric acid/acetic acid mixture under isothermal, isoperibolic and adiabatic conditions. JOURNAL OF HAZARDOUS MATERIALS 2006; 138:452-8. [PMID: 16842908 DOI: 10.1016/j.jhazmat.2006.05.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 05/26/2006] [Accepted: 05/31/2006] [Indexed: 05/10/2023]
Abstract
Runaway phenomena and thermal explosions can originate during the nitration of salicylic acid by means of a nitric acid/acetic acid mixture when the thermal control is lost, mainly as a result of the formation and thermal decomposition of picric acid. The prediction of the behaviour of this system is thus of great importance in view of possible industrial applications and the need to avoid the occurrence of unwanted dangerous events. During a previous investigation a model was developed to simulate its behaviour when the starting concentration of the substrate is too low, thus, preventing the precipitation of poor soluble intermediates. In this work this model is extended to deal with more concentrated systems even in case of a solid phase separating during the process. To this purpose the previously assessed dependence of the solubility of 3-nitro and 5-nitrosalicylic acids upon temperature and nitric acid concentration is included in the model. It is assumed that when 3-nitro and 5-nitrosalicylic acids are partially suspended in the reacting medium a kinetic regime of "dissolution with reaction" is established; that is, the redissolution of these species is a fast process compared to the successive nitration to give dinitroderivatives. Good results are obtained in the comparison of the experimental data with those calculated both in isoperibolic and adiabatic conditions when the revised model is used.
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Affiliation(s)
- R Andreozzi
- Università di Napoli Federico II, p.le V. Tecchio, 80-80125 Napoli, Italy
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24
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Andreozzi R, Canterino M, Caprio V, Di Somma I, Sanchirico R. Salicylic Acid Nitration by Means of Nitric Acid/Acetic Acid System: Chemical and Kinetic Characterization. Org Process Res Dev 2006. [DOI: 10.1021/op060148o] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Roberto Andreozzi
- Università di Napoli “Federico II”, p.le V. Tecchio, 80-80125 Naples, Italy, and Istituto di Ricerche sulla Combustione (CNR), p.le V. Tecchio, 80-80125 Naples, Italy
| | - Marisa Canterino
- Università di Napoli “Federico II”, p.le V. Tecchio, 80-80125 Naples, Italy, and Istituto di Ricerche sulla Combustione (CNR), p.le V. Tecchio, 80-80125 Naples, Italy
| | - Vincenzo Caprio
- Università di Napoli “Federico II”, p.le V. Tecchio, 80-80125 Naples, Italy, and Istituto di Ricerche sulla Combustione (CNR), p.le V. Tecchio, 80-80125 Naples, Italy
| | - Ilaria Di Somma
- Università di Napoli “Federico II”, p.le V. Tecchio, 80-80125 Naples, Italy, and Istituto di Ricerche sulla Combustione (CNR), p.le V. Tecchio, 80-80125 Naples, Italy
| | - Roberto Sanchirico
- Università di Napoli “Federico II”, p.le V. Tecchio, 80-80125 Naples, Italy, and Istituto di Ricerche sulla Combustione (CNR), p.le V. Tecchio, 80-80125 Naples, Italy
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25
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van Bodegraven AA, Mulder CJJ. Indications for 5-aminosalicylate in inflammatory bowel disease: is the body of evidence complete? World J Gastroenterol 2006; 12:6115-23. [PMID: 17036381 PMCID: PMC4088103 DOI: 10.3748/wjg.v12.i38.6115] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 11/28/2005] [Accepted: 02/20/2006] [Indexed: 02/06/2023] Open
Abstract
Mesalazine is a safe drug, although adverse events may be seen in a minority of patients. This applies also to pregnant women and children. The role of mesalazine in combination therapy to improve efficacy and concomitant drug pharmacokinetics, or in chemoprevention against inflammatory bowel disease (IBD)-related colonic carcinoma has not yet been completely elucidated. Therapeutic success of mesalazine may be optimized by a combination of high dose and low frequency of dosage to improve compliance. Therefore, due to its superior safety profile and pharmacokinetic characteristics, mesalazine is preferable to sulphasalazine. This paper reviews the literature concerning mechanisms of action, indications and off-label use, pharmacokinetic properties and formulations, therapeutic efficacy, compliance, paediatric indications, chemoprevention, and safety issues and adverse event profile of mesalazine treatment versus sulphasalazine. It also highlights these controversies in order to clarify the potential benefits of mesalazines in IBD therapy and evidence for its use.
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Affiliation(s)
- A A van Bodegraven
- Department of Gastroenterology, VU University medical centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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26
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Abstract
Pancolitis affects approximately 20% to 40% of the total ulcerative colitis population and remains a therapeutic challenge for clinicians. Practitioners must focus on pancolitis when evaluating a patient for ulcerative colitis, because pancolitis is associated with more severe and fulminant disease and a higher rate of colorectal cancer and colectomy. It is imperative for clinicians to be knowledgeable in the clinical course, medications, and appropriate manner to induce and maintain clinical remission to prevent serious sequelae of the disease. The purpose of this article is to provide a review of the treatment of pancolitis for general gastroenterologists, because medical management decisions have life-long effects for this subgroup of patients.
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Affiliation(s)
- Carmen Cuffari
- Johns Hopkins Hospital Division of Gastroenterology and Hepatology Baltimore, Maryland 21287, USA.
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27
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Klotz U. Colonic targeting of aminosalicylates for the treatment of ulcerative colitis. Dig Liver Dis 2005; 37:381-8. [PMID: 15893274 DOI: 10.1016/j.dld.2004.12.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Accepted: 12/16/2004] [Indexed: 12/11/2022]
Abstract
Aminosalicylates (5-aminosalicylic acid) represent drugs of first choice in the treatment of ulcerative colitis. Two different therapeutic approaches have been employed to target the active 5-aminosalicylic acid to its site of action. Either inactive azo-prodrugs (e.g. sulfasalazine, olsalazine, balsalazide) or special galenic formulations have been developed for topical delivery of 5-aminosalicylic acid to the colon. However, as intestinal physiology, the extent of ulcerative colitis as well as drug disposition demonstrate large interindividual differences, acute healing rates (40-80%) and the maintenance of remission are quite variable. Apparently, therapeutic effects depend on local concentrations of 5-aminosalicylic acid in the colonic mucosa whereas systemic drug exposure might be one determinant of side effects. In general, 5-aminosalicylic acid is well tolerated and withdrawal from therapy is rare. Following administration of azo-prodrugs (e.g. olsalazine), lower plasma concentrations and higher delivery into the colon of 5-aminosalicylic acid can be observed in comparison to special galenic formulations of 5-aminosalicylic acid. Whether such changes in drug disposition will affect therapeutic efficacy remains to be proved by clinical data. Consequently, selection of a particular agent should be based primarily on clinical efficacy, profile of adverse effects, patients' acceptance and economic considerations.
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Affiliation(s)
- U Klotz
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Auerbachstrasse 112, D-70376 Stuttgart, Germany.
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28
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Forbes A, Al-Damluji A, Ashworth S, Bramble M, Herbert K, Ho J, Kang JY, Przemioslo R, Shetty A. Multicentre randomized-controlled clinical trial of Ipocol, a new enteric-coated form of mesalazine, in comparison with Asacol in the treatment of ulcerative colitis. Aliment Pharmacol Ther 2005; 21:1099-104. [PMID: 15854171 DOI: 10.1111/j.1365-2036.2005.02442.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND 5-Aminosalicylates remain important in the treatment of ulcerative colitis, but it is uncertain if the various preparations currently available are equivalent given the different delivery systems that exist. Generic prescription of mesalazine (mesalamine) is therefore inappropriate. Ipocol has recently become available as an alternative to Asacol-MR. AIM To compare the two agents in a controlled trial using a non-inferiority design. METHODS Eighty-eight ulcerative colitis patients with a mild to moderate clinical relapse were randomized to one of the two drugs at a daily dose of 2.4 g for 8 weeks. Safety was the key concern; the primary measured end-point was efficacy as judged from a colitis activity index. RESULTS There were no unexpected adverse events of clinical consequence. The colitis score improved similarly in both patient groups (by 2.3 with Ipocol and by 1.5 with Asacol: not significant), and a similar proportion was in clinical remission at the end of the study (26.1% for Ipocol and 28.6% for Asacol: not significant). Systemic steroids were needed in 11.9% of the Asacol-treated patients compared with 6.5% with Ipocol (not significant). CONCLUSION It appears appropriate to conclude that, while not identical to Asacol-MR, Ipocol offers a safe and similarly effective alternative.
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Fadda H, Basit A. Dissolution of pH responsive formulations in media resembling intestinal fluids: bicarbonate versus phosphate buffers. J Drug Deliv Sci Technol 2005. [DOI: 10.1016/s1773-2247(05)50049-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Abstract
Targeting drugs and delivery systems to the colonic region of the gastrointestinal tract has received considerable interest in recent years. Scientific endeavour in this area has been driven by the need to better treat local disorders of the colon such as inflammatory bowel disease (ulcerative colitis and Crohn's disease), irritable bowel syndrome and carcinoma. The colon is also receiving significant attention as a portal for the entry of drugs into the systemic circulation. A variety of delivery strategies and systems have been proposed for colonic targeting. These generally rely on the exploitation of one or more of the following gastrointestinal features for their functionality: pH, transit time, pressure or microflora. Coated systems that utilise the pH differential in the gastrointestinal tract and prodrugs that rely on colonic bacteria for release have been commercialised. Both approaches have their own inherent limitations. Many systems in development have progressed no further than the bench, while others are expensive or complex to manufacture, or lack the desired site-specificity. The universal polysaccharide systems appear to be the most promising because of their practicality and exploitation of the most distinctive property of the colon, abundant microflora.
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Affiliation(s)
- Abdul W Basit
- The School of Pharmacy, University of London, London, England, UK.
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