Systematic review: the use of mesalazine in inflammatory bowel disease

Background Mesalazine is among the medications most commonly prescribed by gastroenterologists, having to a large extent superseded sulfasalazine (sulphasalazine). However, there are still a number of aspects regarding its use which provoke debate and controversy. Aim To provide a systematic assessment of the evidence for the use of mesalazine in ulcerative colitis and Crohn's disease. Methods References were identified using PubMed database. Additional references were identified with related article searches. Results Mesalazine has a clear role in the maintenance of remission in ulcerative colitis and management of mild to moderately active disease, although the efficacy of topical preparations or combined topical and oral is clearly superior to oral alone. Evidence that increasing the dose of oral mesalazine improves efficacy is not clear-cut. The benefits of mesalazine in the management of acute Crohn's disease and the maintenance of remission are questionable and alternative treatments are usually more appropriate. Emerging evidence suggests that maintenance mesalazine reduces the risk of neoplastic progression in chronic ulcerative colitis. Compliance with therapy is thus important, as is an understanding of individuals most likely to default on this. Conclusion Evidence for a beneficial effect of mesalazine is largely confined to the management of ulcerative colitis.