NEW YORK (Reuters Health) – For preventing relapse of ulcerative colitis (UC), mesalamine can be taken once a day rather than twice or three times daily, according to the results of a meta-analysis reported in the American Journal of Gastroenterology online September 6.

“These data suggest that patients with quiescent UC can be switched to once-daily dosing schedules, in an attempt to maximize the convenience of long-term maintenance therapy, without any deleterious effects on disease activity,” conclude Dr. Alexander C. Ford, with Leeds General Infirmary, UK, and colleagues.

They note that adherence rates to maintenance with 5-aminosalicylic acids (5-ASAs) by patients with ulcerative colitis is as low as 40%, partly attributable to the inconvenience of taking the medication two or three times daily.

Divided dosing, the authors continue, originally aimed to reduce the toxicity of sulfasalazine therapy, but newer 5-ASA agents are better tolerated. Once-daily dosing might improve compliance, but efficacy must be equivalent to divided dosing.

To examine these issues, the researchers conducted a systematic review and meta-analysis of RCTs comparing a once-daily dosing schedule of 5-ASAs with more frequent dosing schedules.

They identified seven relevant studies, all of which used mesalamine, involving a total of 2745 patients. The pooled data indicated that 423 (31.4%) patients on once-daily mesalamine relapsed, compared with 461 (33.0 %) patients on a conventional dosing schedule (relative risk of relapse of 0.94) – a nonsignificant difference.

There was also no significant difference between dosing schedules in terms of adherence to therapy, with a relative risk of non-compliance with once-daily versus conventional dosing of 0.87.

While this does not demonstrate that once-daily dosing improves compliance, the authors suggest that it may do so in practice. “Individuals motivated enough to participate in RCTs are unlikely to be truly representative of patients seen in the real world, so there may still be a benefit in this setting, in terms of increased compliance.”

If so, they add, once-daily dosing “may improve adherence, potentially leading to reduced costs to the health service from managing UC.”

Reference:
Once-Daily Dosing vs. Conventional Dosing Schedule of Mesalamine and Relapse of Quiescent Ulcerative Colitis: Systematic Review and Meta-Analysis
Am J Gastroenterol 2011.