New approaches to adherence issues when dosing oral aminosalicylates in ulcerative colitis

Adherence issues with the use of available aminosalicylates for the treatment of ulcerative colitis (UC) are discussed.

In the clinical setting, adherence to aminosalicylate therapy has been less than optimal. Topical formulations are associated with poor retention, abdominal bloating, and discomfort during administration. Although oral formulations are more convenient than topical formulations, many require multiple-daily-dosing regimens and have a high pill burden, which make patient adherence poor. A number of oral aminosalicylate formulations use colonic bacteria to release the active drug. Although these oral formulations are effective for the treatment of active UC, therapy is not optimal with regard to clinical outcome. Because of the short half-life, the vast majority of current therapies require multiple daily dosing. In addition, the dose strength of these formulations ranges from 250 to 500 mg, which requires patients to take several tablets at a time. Some patients may also require additional topical aminosalicylate to maintain treatment efficacy. However, many patients dislike topical formulations, and refill rates have been shown to be much lower than with oral formulations. New aminosalicylate formulations are now being designed to improve dosing schedules and increase patient adherence, potentially improving clinical and economic outcomes. High-dose, oral mesalamine formulations have been designed to reduce pill burden.

While aminosalicylates are recommended as first-line treatment for the reduction of symptoms and the prevention of relapse in patients with mild-to-moderate UC, many available formulations require patients to take multiple tablets or capsules two to four times daily, which may affect adherence. New dosage regimens and delivery systems have been developed or are under development to improve convenience of dosing and potentially improve adherence.