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Clinical tolerance to three 5-aminosalicylic acid releasing preparations in patients with inflammatory bowel disease intolerant or allergic to sulphasalazine

1992; Wiley; Volume: 6; Issue: 1 Linguagem: Inglês

10.1111/j.1365-2036.1992.tb00544.x

1365-2036

M H Giaffer, Claire O’Brien, C D Holdsworth,

Drug Transport and Resistance Mechanisms

SUMMARY The clinical tolerance to three 5‐aminosalicylic acid (5‐ASA) releasing preparations (mesalazine, olsalazine and balsalazide) was assessed in a consecutive series of 43 patients with inflammatory bowel disease who were intolerant to sulphasalazine. The relative contributions to the side‐effects of sulphasalazine made by its two components, 5‐ASA and sulphapyridine, were also assessed in these patients. Thirty‐nine (91%) patients were able to tolerate at least one of the three 5‐ASA preparations. Only four (9%) patients were intolerant to all preparations, having adverse reactions previously experienced with sulphasalazine and presumably related to 5‐ASA rather than sulphapyridine. The clinical tolerance to mesalazine (63%), olsalazine (70%) and balsalazide (70%) was similar, and tolerance to one drug only was found in nine (18%) patients. The commonest adverse reactions associated with 5‐ASA preparations were gastrointestinal. Diarrhoea was a problem in five patients during treatment with olsalazine and three each while on mesalazine and balsalazide. Allergic reactions from 5‐ASA preparations were uncommon; of ten patients with rash following sulphasalazine only one developed a rash with mesalazine. The results of this study indicate that the vast majority of patients with inflammatory bowel disease can be managed with at least one of these four 5‐ASA containing preparations and that the side‐effects of sulphasalazine are multifactorial in aetiology, some being due to the parent molecule, and some to one of its two metabolites, 5‐ASA and sulphapyridine.