Mesalamine in ulcerative colitis

Dr John Marshall is a professor and director in the Division of Gastroenterology at McMaster University and editor in chief of the Journal of the Canadian Association of Gastroenterology.

What is the role of mesalamine (international nonproprietary name mesalazine) in ulcerative colitis?

John Marshall, MD, MSc: Unlike in Crohn disease, we have very robust evidence for efficacy of 5-aminosalicylic acid (5-ASA), or mesalazine, for treatment of ulcerative colitis, both as an induction agent and, of course, as a maintenance agent.

5-ASA in ulcerative colitis can be given orally or it can be given rectally, and rectally through a variety of formulations. We have a very robust evidence base to show that oral 5-ASA is effective as induction and maintenance treatment, that rectal 5-ASA is effective for induction and maintenance, and the fact that the combination of oral and rectal 5-ASA is more effective than either given alone, at least as an induction agent in ulcerative colitis.

It is really the mainstay of therapy for mild to moderate disease, both for induction and maintenance.