Innovative drug for ulcerative colitis continues to show benefit in studies

A study published in a 2002 issue of the American Journal of Gastroenterology has reinforced that balsalazide produces more rapid and effective relief of symptoms in ulcerative colitis (a type of inflammatory bowel disease) compared to other medications. Previous studies have demonstrated that balsalazide is superior to mesalamine due to better methods of drug delivery to the bowel. This study confirms these results as well as further evaluating the safety of balsalazide, showing there are no serious adverse effects associated with even higher doses of this medication.

Ulcerative colitis is an inflammatory disorder of the bowel which along with Crohn’s disease, makes up the group of disorders called Inflammatory Bowel Disease. Ulcerative colitis in confined to the large intestine and characterised by severe inflammation and ulceration of the bowel lining. Patients with ulcerative colitis have frequent and recurrent episodes of abdominal pain and diarrhoea which often contains blood and mucus. The disorder most commonly affects the 15-40 year old age group and causes significant morbidity for its sufferers. Extensive research has gone into identifying the most suitable treatments for relieving symptoms of ulcerative colitis and reducing damage to the large intestine. A class of drugs known as aminosalicylate medications are now the standard treatment for ulcerative colitis in acute exacerbations and for long-term maintenance of remission. A study published in the American Journal of Gastroenterology in 2002 compared two such medications namely, mesalamine and balsalazide, in the treatment of mild-moderate ulcerative colitis for a period of 8 weeks. Both these drugs contain the same active ingredient (5-ASA) but they differ in the way they deliver this to the large intestine. Balsalazide has a more reliable mechanism of release as it can only be broken down by specific enzymes produced by bacteria in the large intestine. Therefore more of the drug gets to the actual target site where it can treat disease. In addition, less of the drug gets prematurely absorbed into the bloodstream thus reducing damage to other organs such as the kidney (responsible for filtering blood and producing urine). This is partly the reason why balsalazide has been shown to produce more rapid and reliable results than mesalamine in various studies. The current study was conducted in the United States and Puerto Rico on 154 patients with ulcerative colitis confirmed by sigmoidocsopy (insertion of a small, flexible tube with a camera via the back passage to visualise the inside of the distal bowel). Patients received one of three regimens for 8 weeks- high-dose balsalazide (6.75g daily), low-dose balsalazide (2.25g daily) or mesalamine (2.4g daily). Neither the patients nor doctors knew what the patients were taking so that they could be fairly compared. The main results showed that higher doses of balsalazide produced greater improvements in symptoms of rectal bleeding and stool frequency and overall improvement of disease on sigmoidoscopy. In addition, high dose balsalazide produced earlier and better improvements in symptoms compared to an equivalent dose of mesalamine. Furthermore this study showed there were no significant adverse effects of high dose balsalazide compared to the lower dose or the alternative medication mesalamine. This study was well designed and thus provided reliable evidence on the benefits and safety of high doses of a relatively new drug, balsalazide, in the treatment of mild-moderate ulcerative colitis. In conjunction with previous research, it can therefore help doctors decide which treatment is the best for managing patients with ulcerative colitis both in the short and long term. Hopefully appropriate use of this medication will lead to better symptom control and reduction of the burden of this common disease on the community. If you from suffer ulcerative colitis this medication may be helpful for you but you should discuss all treatment options fully with your doctor.