P636 Which is the real life maintenance mesalazine dose in ulcerative colitis
A. Algaba*1, I. Guerra1, A. García- García de Paredes2, M. de Lucas1, C. Ferre2, D. Bonillo1, L. Aguilera2, A. López-Sanromán2, F. Berrmejo1
1Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain, 2Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain
Mesalazine (MSZ) is frequently used as maintenance therapy for ulcerative colitis (UC). However, the real life dose used by clinicians is still a mystery. In our study, we wanted to describe how MSZ is used in our practice, at which dose, and with what success (regarding adherence to therapy).
Transversal study, including all patients with UC and with MSZ maintenance therapy (at least for 6 months) seen in scheduled outpatient visits during September and October, 2014, in two IBD Units in Madrid, Spain. Patients receiving immunosuppresors or biologicals were excluded. Treatment adherence was measured by the Morisky-Green scale.
We included 90 patients (mean age 52 ± 15 y; 52% females, 13.5% smokers). The mean disease duration was 10 ± 8 y. Topical MSZ was used in 35 cases (39%). Mean MSZ dose was 3 ± 2.4 g/d, for a mean of 38 ± 46 months. Doses <2 g/d were used in 13.3% of cases, from 2-2.9 g/d in 35.6%, from 3-3.9 in 23% and ≥ 4 g/d in the remaining 27.8%. A single daily dose was preferred in 45%, two doses in 36% and three doses in 19%. A different MSZ brand had been previously used in 40% of patients. Reasons for change were medical decision (n=21; 60%), side effects (n=7; 20%), patient's choice (n=5; 14.3%) or poor treatment compliance (n=2; 5.7%). During the year preceding the study, 55 patients were in remission (62%), whilst the remaining had suffered at least one flare. In 59 cases, the maintenance dose had been increased during a flare, and in 26 this higher dose had been kept for maintenance (40%, dose ≥ 4 g/d in 73%); in the remaining, the dose was lowered after a period of time (to 2 g/d in 50%). During the MSZ therapy, 8 patients were admitted (9%), 10 took drug holidays (90% due to patient's request, after a prolonged remission) and 10 (11%) suffered mild side effects (30% altered liver function tests). Therapy adherence was good in 83.3% of cases.
More than half of our UC patients take high MSZ doses (3-4 g/d) as maintenance therapy, with acceptable safety and good adherence. Variable doses are used in clinical practice, highlighting the need to tailor dose according to UC behavior. Almost half of all patients are prescribed a different commercial brand during therapy, and a similar percentage takes a single daily dose. Opting for a higher MSZ maintenance dose is a possible strategy for a satisfactory maintenance therapy.