Randomised clinical trial: mesalazine versus placebo in the prevention of diverticulitis recurrence

BACKGROUND

Previous studies have reached conflicting conclusions regarding the efficacy of mesalazine in the prevention of recurrent diverticulitis.

AIM

To investigate the efficacy and safety of mesalazine granules in the prevention of recurrence of diverticulitis after acute uncomplicated diverticulitis.

METHODS

Two phase 3, randomised, placebo-controlled, double-blind multicentre trials (SAG-37 and SAG-51) investigated mesalazine granules in patients with prior episodes (<6 months) of uncomplicated left-sided diverticulitis. Patients were randomised to receive either 3 g mesalazine once daily or placebo (SAG-37, n=345) or to receive either 1.5 g mesalazine once daily, 3 g once daily or placebo for 96 weeks (SAG-51, n=330). The primary endpoint was the proportion of recurrence-free patients during 48 weeks (SAG-37 and SAG-51) or 96 weeks (SAG-51) of treatment.

RESULTS

Mesalazine did not increase the proportion of recurrence-free patients over 48 or 96 weeks compared to placebo. In SAG-37, the proportion of recurrence-free patients during 48 weeks was 67.9% with mesalazine and 74.4% with placebo (P=.226). In SAG-51, the proportion of recurrence-free patients over 48 weeks was 46.0% with 1.5 g mesalazine, 52.0% with 3 g mesalazine and 58.0% with placebo (P=.860 for 3 g mesalazine vs placebo) and over 96 weeks 6.9%, 9.8% and 23.1% respectively (P=.980 for 3 g mesalazine vs placebo). Patients with only one diverticulitis episode in the year prior to study entry had a lower recurrence risk compared to >1 episode. Safety data revealed no new adverse events.

CONCLUSION

Mesalazine was not superior to placebo in preventing recurrence of diverticulitis.

Synthesis and anti-HIV-1 activity of 4,5,6,7-tetrahydro-5-methylimidazo [4,5,1-jk][1,4]benzodiazepin-2(1H)-one (TIBO) derivatives. 3

4,5,6,7-Tetrahydro-5-methylimidazo[4,5,1-jk][1,4]benzodiazepin-2 (1H)-ones (TIBO), 1, have been shown to significantly inhibit HIV-1 replication in vitro by interfering with the virus's reverse transcriptase enzyme. They have also demonstrated potential clinical efficacy in combating HIV-1, on the basis of a preliminary study. Our prior publications have discussed the discovery of this series of compounds and reported some preliminary chemical and biological studies around N-6 substitutions and 5-membered ring variations of 1. This manuscript describes our synthetic endeavors around 4, 5, and 7 mono- and disubstitutions of 1 and discusses related HIV-1 inhibitory structure-activity relationships. On the basis of inhibition of HIV-1's cytopathic effects in MT-4 cells, we found that 5-mono-Me-substituted analogues, the original substitution in the early lead compounds, and 7-mono-Me-substituted analogues of 1 were comparable as being consistently the most active compounds. Although generally less active, the 4,5,7-unsubstituted, 4-mono-substituted, cis- and trans-5,7-di-Me-substituted, and cis-4,5-di-Me-substituted analogues of 1 also exhibited some significant desired activity. The remaining trans-4,5-di-Me-substituted, cis- and trans-4,7-di-Me-substituted, and all 4,5-, 5,6-, 6,7-, and 7,8-fused disubstituted analogues of 1 possessed no noticeable desired activity.

Methyl 2-tetradecylglycidate, an orally effective hypoglycemic agent that inhibits long chain fatty acid oxidation selectively

The oral hypoglycemic agents methyl 2-tetradecylglycidate (McN-3716) and 2-tetradecylglycidic acid (McN-3802), synthesized in an effort to design a specific inhibitor of long-chain free fatty acid (FFA) oxidation, were tested for their effects on rat hemidiaphragm oxidation of various substrates to CO2. When added in vitro, both compounds were more potent (100-1000 times) in inhibiting long-chain FFA oxidation than either a-bromopalmitic or 4-pentenoic acid. When fasting normal or diabetic rats were pretreated with McN-3716, the ability of the diaphragms to oxidize palmitate-1-l4C to 14CO2 incubated in vitro was also diminished. Closely related nonhypoglycemic analogs of McN-3716 failed to inhibit oxidation. The failure of McN-3716 to inhibit the oxidation by diaphragm of short-chain fatty acids, palmitoyl camitine, glucose, glycolytic intermediates, β-hydroxybutyrate, succinate, or citrate when added in vitro or after treatment of rats suggests that glycolysis, the tricarboxylic acid cycle, and the intramitochondrial β-oxidation of fatty acids were not inhibited. While depressing FFA oxidation, McN-3716 increased the ability of hemidiaphragms from normal and diabetic rats to oxidize glucose-14C to 14CO2. This supports an intimate relationship between FFA oxidation and glucose utilization in hemidiaphragm. The locus of this stimulation appears to be the glycolytic pathway. The earliest onset for the impairment of diaphragm muscle FFA oxidation and the rise of plasma FFA after treatment of fasting rats with McN-3716 preceded the stimulation of hemidiaphragm glucose oxidation and the lowering of plasma glucose and tissue glycogen stores. These results suggest that the carbohydrate changes are secondary to the inhibition of FFA oxidation.