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Transdermal nicotine for active ulcerative colitis

R D Pullan1, J Rhodes, S Ganesh

  • 1Department of Gastroenterology, University Hospital of Wales, Cardiff, United Kingdom.

The New England Journal of Medicine
|March 24, 1994
PubMed
Summary
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Transdermal nicotine patches significantly improved ulcerative colitis symptoms in a randomized trial. This nicotine therapy offers a potential new treatment option for patients experiencing ulcerative colitis flare-ups.

Area of Science:

  • Gastroenterology
  • Pharmacology

Background:

  • Ulcerative colitis (UC) is primarily a disease affecting nonsmokers.
  • Anecdotal evidence suggests smoking and nicotine may alleviate UC symptoms.

Purpose of the Study:

  • To investigate the efficacy of nicotine as a supplemental treatment for active ulcerative colitis.

Main Methods:

  • A randomized, double-blind, placebo-controlled study involving 72 patients with active ulcerative colitis.
  • Patients received either transdermal nicotine patches or placebo patches for six weeks, alongside their existing mesalamine and/or glucocorticoid therapy.
  • Clinical, sigmoidoscopic, and histologic assessments were performed, alongside daily symptom recording and monitoring of side effects and plasma nicotine levels.

Main Results:

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  • Complete remission was achieved in 17 of 35 patients (48.6%) in the nicotine group versus 9 of 37 (24.3%) in the placebo group (P = 0.03).
  • Significant improvements were observed in the nicotine group for global clinical grade (P < 0.001), histologic grade (P = 0.03), stool frequency (P = 0.008), abdominal pain (P = 0.05), and fecal urgency (P = 0.009).
  • More side effects were reported in the nicotine group (nausea, lightheadedness, headache, sleep disturbance), but withdrawals due to ineffective therapy were more common in the placebo group.

Conclusions:

  • Transdermal nicotine, when added to conventional maintenance therapy, effectively improves symptoms in patients with ulcerative colitis.
  • Nicotine demonstrates potential as an adjunctive treatment for managing ulcerative colitis symptoms.