, Volume 38, Issue 10, pp 1843-1850

Better quality of therapy with 5-ASA colonic foam in active ulcerative colitis

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Abstract

We evaluated the efficacy, tolerance, and acceptance of a new 5-ASA colonic foam versus 5-ASA liquid enema in the short-term treatment of active ulcerative colitis in a three-week prospective, randomized, investigator-blind study, enrolling 233 patients from 12 outpatient clinics in Italy. In arm 1 of the study, 117 patients with mild attacks received 2 g of 5-ASA as foam or enema at bedtime. In arm 2, 116 patients with moderate attacks were given 4 g of 5-ASA as foam or enema at bedtime. End points were defined as complete relief of symptoms, and endoscopic and histological evidence of remission or improvement. In patients with mild relapse, 34 of 63 (54%) treated with foam were in clinical remission after only 10 days compared with 17 of 51 (31%) treated with enemas (P<0.05). However, there was no statistically significant difference between foam (83%) and enema (74%) after three weeks. In patients with moderate relapse, a higher proportion of patients achieved complete clinical remission in the foam group (63%) compared with enema group (52%) after three weeks (difference 11%, 95% CI −7 to 29). No significant differences were observed in endoscopic and histological evaluation of colonic mucosa between treatment groups in either arm. 5-ASA foam was well tolerated. No unexpected adverse events were reported. Patient evaluation of therapy showed that foam was much better accepted than enema because foam was more comfortable, more practical, easier to retain, and interfered less with daily living. The results of this study suggest that 5-ASA foam may provide prompter remission of symptoms compared to liquid enema and it improves the quality of topical therapy in ulcerative colitis.

This paper was presented in part at the Research Forum of the 92nd annual meeting of The American Gastrointestinal Association, New Orleans, May 18–24, 1991.
The multicenter group included: M. Campieri, A. Belluzzi, G. Brunetti, P. Gionchetti, M. Miglioli, L. Barbara (Bologna); C. Prantera, A. Andreoli, E. Berto (Roma); P. Paoluzi, M.C. Di Paolo, A.O. Paoluzi (Roma); F. Pallone, F. Luzza (Catanzaro); M. Cottone, L. Oliva (Palermo); G. Bianchi Porro, S. Ardizzone, M. Petrillo (Milano); G. D'Albasio, G. Trallori (Firenze); G.C. Sturniolo, M.C. Montino (Padova); A. Pera, C. Barletti (Torino); R. de Franchis, G. Grandinetti, G.M. Meucci, M. Vecchi (Milano); P. Bianchi, M.C. Campanini, T. Ranzi (Milano); L. Capurso, C. Papi (Roma).
Supported by a grant from Bracco and Giuliani (Milan, Italy).