Journal Article

Once daily versus three times daily mesalazine granules in active ulcerative colitis: a double-blind, double-dummy, randomised, non-inferiority trial

Mueller, R, Gorelov, I A, Batovsky, M, Rácz, I, Boehm, S, Kykal, J, Horynski, M, Kruis, W, Greinwald, R, Kiudelis, G, Pokrotnieks, J

2009

Overview

Objectives:To determine the therapeutic equivalence and safety of once daily (OD) versus three times daily (TID) dosing of a total daily dose of 3 g Salofalk (mesalazine) granules in patients with active ulcerative colitis.Design:A randomised, double-blind, double-dummy, parallel group, multicentre, international, phase III non-inferiority study.Setting:54 centres in 13 countries.Patients:380 patients with confirmed diagnosis of established or first attack of ulcerative colitis (clinical activity index (CAI)>4 and endoscopic index ⩾4 at baseline) were randomised and treated.Interventions:8-week treatment with either 3 g OD or 1 g TID mesalazine granules.Main outcome measures:Clinical remission (CAI⩽4) at study end.Results:380 patients were evaluable for efficacy and safety by intention-to-treat (ITT); 345 for per protocol (PP) analysis. In the ITT population, 79.1% in the OD group (n = 191) and 75.7% in the TID group (n = 189) achieved clinical remission (p<0.0001 for non-inferiority). Significantly more patients with proctosigmoiditis achieved clinical remission in the OD group (86%; n = 97) versus the TID group (73%; n = 100; p = 0.0298). About 70% of patients in both treatment groups achieved endoscopic remission, and 35% in the OD group and 41% in the TID group achieved histological remission. About 80% of all patients preferred OD dosing. Similar numbers of adverse events occurred in 55 patients (28.8%) in the OD group and in 61 patients (32.3%) in the TID group, indicating that the two dosing regimens were equally safe and well tolerated.Conclusions:OD 3 g mesalazine granules are as effective and safe as a TID 1 g schedule. With respect to the best possible adherence of patients to the treatment, OD dosing of mesalazine should be the preferred application mode in active ulcerative colitis.ClinicalTrials.gov Identifier:NCT00449722

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Anti-Inflammatory Agents, Non-Steroidal - administration & dosage / Anti-Inflammatory Agents, Non-Steroidal - therapeutic use / Chi-Square Distribution / Clinical trials / Colitis, Ulcerative - drug therapy / Colitis, Ulcerative - pathology / Colonoscopy / Compliance / Crohn's disease / Double-Blind Method / Drug Administration Schedule / Endoscopy / Family medical history / Female / Humans / Inflammatory Bowel Disease / Kaplan-Meier Estimate / Male / Mesalamine - administration & dosage / Mesalamine - therapeutic use / Middle Aged / Patient Compliance / Sample Size / Treatment Outcome