Ultra-high dose of mesalamine to treat steroid-dependent ulcerative colitis
Notice bibliographique
Résumé
To the Editor: To the best of our knowledge, the use of ultra-high doses of mesalamine to treat ulcerative colitis (UC) has not been previously reported. We are reporting a UC patient whose treatment with an ultra-high dose of mesalamine resulted in the ability to eliminate steroid-dependence. A 25 year old male presented in another city with bloody diarrhea, and was diagnosed with ulcerative pan-colitis. He was initially treated with a cortico-steroid and mesalamine (Salofalk, Mesalamine Delayed Release Tablets USP, Aptalis Pharma Canada Inc.) 4.0 g/day. Because of steroid dependency, azathioprin was added. After being steroid-dependent for 6 months on triple therapy (prednisone 20–30 mg/day, mesalamine 4 g/day, and azathioprine 150 mg/day), he was advised to start anti-TNF therapy. He declined, and sought another opinion. The second gastroenterologist switched him from Salofalk tablets to mesalamin (MezavantR, 1.2 g Delayed-and Extended-Release Tablets, Shire Canada Inc.). The patient assumed that the dosing regimen was the same, and took 4.8 g BID. Soon after the 5-ASA therapy was increased to the ultra-high dose of 9.6 g/day, he was able to taper and stop prednisone for the first time since his diagnosis, and remain in clinical remission. At that time he moved to Toronto, and was referred to us for ongoing management. When we first encountered the patient, he had been on the ultra-high dose of 5-ASA for 6 months. We did not observe any adverse effects of this ultra-high dose of mesalamine. He was tolerating the ultra-high dose of mesalamine very well, and his urinalysis, complete blood count, liver and kidney profiles were all within the normal range. Thiopurine metabolite levels were therapeutic. While some studies have shown that higher doses of delayed-release mesalamine produced greater mucosal healing and faster colitis improvement versus lower doses 1, other trials have not shown the same results for doses ranging from 1.6 to 4.8 g 2. It has been shown that standard high oral doses of 5-ASA (from 2.4 to 4.8 g/day) can be effective in reducing or eliminating steroids in up to 50% of patients with steroid-dependent UC 3. Studies have shown that the colonic mucosal concentrations of 5-ASA are significantly higher in patients receiving combined oral and topical formulations compared to oral therapy alone, and that there is an inverse relationship between mucosal concentrations of 5-ASA and colitis disease activity, as measured by histological or endoscopic evaluations 4. We believe that an ultra-high dose of mesalamine should result in higher colonic mucosal concentrations of 5-ASA, hence a greater chance of effective disease control. Since mesalamine has not been reported to have dose-related side effects 5, one might anticipate that other patients would be able to tolerate ultra-high doses of mesalamine. In conclusion, using higher than recommended doses of mesalamine may have an important role in achieving clinical remission in selected ulcerative colitis patients. Further clinical studies are needed to examine the potential benefits and risks of an ultra-high dose of mesalamine in UC patients. Nil. No conflict of interest for any of the authors. Conception and design: Fred Saibil, Soleiman B Kashkooli; acquisition of data, initial drafting: Soleiman B Kashkooli, Mehrdad Rouhani; preparation of the final transcript: Soleiman B Kashkooli; critical revision of the transcript and supervision: Fred Saibil. All authors read and approved the final version of the transcript.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,002 | 0,000 |
| Intégrité de la recherche | 0,012 | 0,010 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».