Mesalamine derivatives in the treatment of Crohn's disease

The role of the aminosalicylates for induction therapy of mild to moderate UC and as maintenance treatment has been substantiated by a large series of controlled clinical trials and confirmatory meta-analyses. Both sulfasalazine and the newer 5-ASA formulations have been found to be effective in the treatment of active mild to moderate UC, with a trend favoring the newer 5-ASA drugs that is related to the safety of the non-sulfa-containing formulations. Both sulfasalazine and newer derivatives are effective in preventing relapses. The optimal dose has yet to be clarified for each clinical scenario, although there is a wide safety range for mesalamine formulations up to at least 4.8 g daily. It remains to be determined whether certain high-risk groups of patients may benefit from higher doses of mesalamine induction or maintenance therapy. Mesalamine derivatives are also of benefit in the treatment of Crohn's disease. Sulfasalazine is effective in mild to moderate disease involving the colon, but not for isolated small bowel disease. Formulations delivering mesalamine to the small bowel and proximal colon seem effective in the treatment of mild to moderate active disease, although the efficacy is less than corticosteroids. Sulfasalazine is likely not effective in the maintenance of Crohn's disease, although other mesalamine formulations continue to show some prophylactic activity after mesalamine-induced remissions and for patients with disease of the ileum who have undergone surgical resection.