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New Options in Medical Treatment of Ulcerative Colitis: Presented at DDW

By Crystal Phend

LOS ANGELES, C.A. -- May 29, 2006 -- Medical therapy options for ulcerative colitis have improved and new agents are on the horizon that may further delay the need for surgical treatment, researchers said here at Digestive Diseases Week 2006 (DDW).

The 5-aminosalicylate agents are effective for management of patients with ulcerative colitis, but different formulations may have different levels of efficacy, said Michael Kamm, MD, chair of medicine, St. Marks Hospital, London, United Kingdom.

More than half of patients have improvement of their active colitis when treated with 2 g of 5-aminosalicylate twice daily, but remission rates differ by agent, Dr. Kamm said during his presentation on May 23^rd.

Dose-ranging studies have had conflicting data as to whether higher doses are more effective than lower doses. Dr. Kamm said this is likely due to differences in formulation rather than the quality of the studies themselves. This issue of formulation "is becoming an increasingly important one," he said.

"In patients with active, extensive disease in whom you are using mesalamine, combination oral and rectal therapy offers advantages," he explained. If overnight suppositories are not effective, 24-hour formulations should be tried.

However, in most patients, "twice-daily dosing results in both doses reaching the colon at roughly the same time," Dr. Kamm said. Therefore, once-daily dosing may be feasible. Pentasa 1- or 2-g sachets, Asacol 800-mg tablets, and SPD476 1.2-gm tablets are now available.

"I think this trend toward higher dose preparations is important," he said.

Edward Loftus, MD, associate professor of medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona, in another presentation on May 23^rd, said that new agents are also on the horizon for patients with moderate to severe ulcerative colitis, to delay or prevent the need for colectomy surgery.

One interesting new treatment in development is MNL-02 (LDP-02), a humanized monoclonal antibody against alpha-4 integrin that "looks like a promising agent," he said.

Leukocytapheresis, which involves passing the blood through a filter for white blood cells, is being compared to sham in an ongoing large North American clinical trial, which may shed more light on its utility.

For patients who are refractory to intravenous steroids, the as-yet-unapproved agent visilizumab appears to have a 1-month remission rate of 50% and 73% rate with a durable response and no signs of opportunistic infections.

Dr. Loftus said it may be time to change the therapeutic approach for active ulcerative colitis. Topical steroids and aminosalicylates are good for mild disease; infliximab, systemic corticosteroids and oral steroids for moderate ulcerative colitis; and infliximab, cyclosporine, and finally surgery for severe disease.

Azathioprine and 6-mercaptopurine should be in the treatment algorithm as well, but it is less clear at which point they should be initiated.


[Presentation titles: 5-Aminosalicylate Therapy for Ulcerative Colitis. Abstract Sp619. Medical Therapy for Refractory Ulcerative Colitis. Abstract Sp620]

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