Clinical trial: a novel high-dose 1 g mesalamine suppository (Salofalk) once daily is as efficacious as a 500-mg suppository thrice daily in active ulcerative proctitis

BACKGROUND

Mesalamine suppositories are first-line therapy in active ulcerative proctitis; the standard regime still recommends multiple doses per day. The primary objective of this study was to show the noninferiority of once-daily administration of a novel 1 g mesalamine suppository versus thrice-daily administration of the 0.5 g mesalamine suppository.

METHODS

This was a single-blind (investigator-blinded), randomized, multicenter, comparative, Phase III clinical trial. Patients with mild to moderately active ulcerative proctitis inserted either one mesalamine 1 g suppository at bedtime or one mesalamine 0.5 g suppository thrice daily over a 6-week period. The primary endpoint was rate of remission (Disease Activity Index below 4).

RESULTS

In all, 354 patients were evaluable for safety and per-protocol analysis. The new regimen demonstrated noninferiority: The percentage of patients with remission was 87.9% for the once-daily 1 g mesalamine suppository and 90.7% for the thrice-daily 0.5 g mesalamine suppository. Each regimen resulted in prompt cessation of clinical symptoms (e.g., median time to ≤3 stools per day (all without blood): 5 days in the 1 g mesalamine once-daily and 7 days in the 0.5 g mesalamine thrice-daily group). Patients preferred applying suppositories once a day.

CONCLUSIONS

In active ulcerative proctitis the once-daily administration of a 1 g mesalamine suppository is as effective and safe, yet considerably more convenient, than the standard thrice-daily administration of a 0.5 g mesalamine suppository.

Treatment algorithms in the case of perianal complications of Crohn's disease

AIM

To construct an algorithm of the treatment tactics which would include modern conservative and surgical methods.

MATERIALS AND METHODS

Endoscopy under anesthesia, endorectal ultrasonography, histological and radiological examinations, MRT. In the last 22 years, 310 patients with Crohn's disease (CD) have been treated in our clinic of which 144 had perianal complications (60 fissure, 52 fistula, 61 perianal abscess).

RESULTS

The treatment of perianal abscesses is opening and drainage, followed by conservative treatment (local and systemic). Using conservative treatment for patients with fissure, clinical remission was attained in 45 (75%); another 15 patients (25%) were operated using Maslyak's method. We have not conducted surgical treatment of fissures for the last 5 years. 51 patients with fistulas were operated on. When the malignization was confirmed, we conducted extirpation of the rectum or coloproctectomy. Recurrence of CD was observed in 65 patients (45.1%) during the first 2 years after the beginning treatment and in 128 patients (88.9%) during 5 years. CDAI varied from 150 to 450. PCDAI was in the range of 5-20.

CONCLUSIONS

(1) Planned surgical treatment of perianal complications requires complex examination of the gastrointestinal tract; (2) pararectal fistulas should be operated in the period of complete remission; (3) surgical treatment of perianal complications should be microinvasive, using non-cutting seton, fistulotomy and advancement flap, and (4) coloproctectomy is the final stage of treatment of perianal CD in severe cases.