Aminosalicylates in inflammatory bowel disease

Aminosalicylates are the mainstay of therapy for mild to moderate ulcerative colitis (UC) and for maintenance of remissions. Topical (rectal) agents are more efficacious than oral agents for distal disease, although most patients will still prefer and respond to oral formulations. The potential of sulfasalazine to have a modest benefit versus other oral formulations is offset by significantly increased adverse events. In Crohn's disease (CD), the use of sulfasalazine is limited to mild to moderate ileocolonic or colonic disease at higher doses (up to 6 g/d). Although the response to oral mesalamine is 40% to 50% in mild to moderate CD, statistically significant improvement versus placebo has not been shown with this agent. Likewise, controversy exists regarding whether mesalamine is effective at maintenance of medically or surgically induced remissions in CD. Current trials are evaluating the efficiency of higher doses of mesalamine of up to 6 g/day.