The cost‐utility of high dose oral mesalazine for moderately active ulcerative colitis

Buckland, Andrew; Bodger, Keith

doi:10.1111/j.1365-2036.2008.03856.x

Cited by 31 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A British cost-utility analysis suggested that high-dose mesalamine is more cost-effective than standard-dose mesalamine over 12-weeks in patients with moderate UC. 69 However, the small incremental benefit with high-dose mesalamine should be discussed with patients in the context of potential risks associated with delaying more effective, albeit immunosuppressive therapy. The benefit of continuing high-dose mesalamine for maintenance of remission is unclear, with moderate confidence in estimates supporting a small benefit, over standard-dose mesalamine.…”

Section: Questionmentioning

confidence: 99%

AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis

et al. 2019

View full text Add to dashboard Cite

Most patients with ulcerative colitis (UC) have mild-tomoderate disease activity, with low risk of colectomy, and are managed by primary care physicians or gastroenterologists. Optimal management of these patients decreases the risk of relapse and proximal disease extension, and may prevent disease progression, complications, and need for immunosuppressive therapy. With several medications (eg, sulfasalazine, diazo-bonded 5-aminosalicylates [ASA], mesalamines, and corticosteroids, including budesonide) and complex dosing formulations, regimens, and routes, to treat a disease with variable anatomic extent, there is considerable practice variability in the management of patients with mild-moderate UC. Hence, the American Gastroenterological Association prioritized clinical guidelines on this topic. To inform clinical guidelines, this technical review was developed in accordance with the Grading of Recommendations Assessment, Development and Evaluation framework for interventional studies. Focused questions included the following: (1) comparative effectiveness and tolerability of different oral 5-ASA therapies (sulfalsalazine vs diazo-bonded 5-ASAs vs mesalamine; low-(<2 g) vs standard (2-3 g/d) vs high-dose (>3 g/d) mesalamine); (2) comparison of different dosing regimens (once-daily vs multiple times per day dosing) and routes (oral vs rectal vs both oral and rectal); (3) role of oral budesonide in patients mild-moderate UC; (4) comparative effectiveness and tolerability of rectal 5-ASA and corticosteroid formulations in patients with distal colitis; and (5) role of alternative therapies like probiotics, curcumin, and fecal microbiota transplantation in the management of mild-moderate UC.

show abstract

Section: Questionmentioning

confidence: 99%

AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Recognizing increased doses in the management of active UC, Buckland compared the cost-effectiveness of low-dose versus high-dose mesalazine. The investigators found that using 4.8 g/day in comparison with 2.4 g/day was cost saving and improved QoL because of improved remission rates [44]. This is, however, controversial, as efficacy is not consistently higher with higher oral doses.…”

Section: Compliancementioning

confidence: 91%

Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine

Munkholm¹,

Michetti²,

Probert³

et al. 2010

European Journal of Gastroenterology & Hepatology

View full text Add to dashboard Cite

Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can improve not only patient quality of life, and decrease the number harmed by adverse events from more potent drugs, but can also save valuable healthcare costs by avoiding high-cost treatment interventions associated with acute ulcerative colitis. This review will consider several elements of mesalazine management from the patient perspective based on a range of clinical and patient-focused evidence. By highlighting patient preferences in disease management it is envisaged that this review will aid physicians to optimize treatment decisions with the different mesalazine preparations available.

show abstract

“…enteric coated products) are generally employed to maximise drug delivery to the affected regions while minimising systemic absorption. 5-ASA is generally administered at the dosage regimen of 2.4 g/day, even though recent clinical trials have convincingly demonstrated that by doubling the standard dose of mesalamine, both safety and efficacy and hence cost-effectiveness can be improved, with no increase in adverse events (Buckland and Bodger, 2008). However, most of the oral formulations currently available on the market are associated with a number of limitations, mainly a relatively low drug dosage (generally 500 mg 5-ASA/unit).…”

Section: -Asa Treatment Requirementsmentioning

confidence: 99%

Extrusion–spheronisation of highly loaded 5-ASA multiparticulate dosage forms

Pretoro¹,

Zema²,

Gazzaniga³

et al. 2010

International Journal of Pharmaceutics

View full text Add to dashboard Cite

The aim of the current work was to develop an extrusion-spheronisation (E-S) route to manufacture pellets with a high loading (≥90wt%) of 5-aminosalicylic acid (5-ASA). Ram extrusion studies, supported by centrifuge testing, were employed to investigate the effect of the chemical (acidity) and physical (particle size and shape) characteristics of 5-ASA on the ability of microcrystalline cellulose (MCC)-based pastes to retain water when subjected to pressure. Liquid phase migration (LPM) within the paste during the extrusion, and hence variation in water content of extrudates and reproducibility of the final E-S product, was generally observed. The extent of LPM was found to be related to both the drug loading and its physical properties, most notably the particle shape (needle-like). A reduction in particle size, combined with a change in the shape of the 5-ASA particles, allowed LPM to be reduced considerably or eliminated. The performance of colloidal grades of MCC (Avicel RC591 and CL611) as alternative extrusion aids to the standard Avicel PH101 was also investigated: these proved to be superior aids for the highly loaded 5-ASA pastes as their greater water retention capacity mitigated LPM. Combining these results yielded a route for manufacturing pellets with 5-ASA loading ≥90wt%.

show abstract

The cost‐utility of high dose oral mesalazine for moderately active ulcerative colitis

Cited by 31 publications

References 21 publications

AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis

AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis

Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine

Extrusion–spheronisation of highly loaded 5-ASA multiparticulate dosage forms

Contact Info

Product

Resources

About