Mesalamine Suppository Treatment in Crohnʼs Disease of the Pouch

Abstract

Introduction: Mesalamine suppository is used to treat mild or moderate active left-sided colitis, pancolitis, or extensive colitis. However, there are no published data on its efficacy and safety in Crohn's disease (CD) of the pouch. Aim of this study was to evaluate the efficacy and safety of mesalamine suppository in patients with CD of the pouch. Methods: This case series included all patients with CD of the pouch from our prospectively maintained, IRB-approved Pouchitis Registry from 2007 to 2017. All patients were either actively taking mesalamine suppository or had used it in the past. Disease activity in pouch patients can be monitored using the modified Pouchitis Disease Activity Index (mPDAI) scores, consisting of symptom and endoscopy subscores. Pre- and post- treatment (minimum 6 months) pouchoscopy and clinical visits were used to calculate mPDAI symptom (range 0 - 6) and endoscopy (range 0 - 6) subscores. Analysis was performed using the paired nonparametric test, SPSS 22.0. Results: A total of 8 patients were included in this study, who underwent restorative proctocolectomy with ileal pouch anal anastomosis due to medical refractory ulcerative colitis (UC). The mean age at the time of pre-colectomy diagnosis of UC was 25.0±11.5 years. The mean current age was 46.1 ±15.3 years, with 4 (50.0%) being females, 1(12.5%) having smoked and 6 (75.0%) having used anti-tumor necrosis factor agents prior to mesalamine suppository use. The mean duration of mesalamine suppository use was 7.9±3.7 months. Patients on mesalamine suppository noted to have statistically significant lower mPDAI symptom subscores post treatment using univariate analysis (6.38±1.40 and 2.60±0.70, P = 0.011). Numerical improvement in endoscopy subscores was also noted with mesalamine suppository use. The pre- and post- treatment mean endoscopy subscores were 0.77±1.72 and 0.50±1.07 in the afferent limb (P =0.180); 1.56±1.94 and 1.13±1.80 (P =0.279) in the pouch body; and 2.00±1.87 and 1.75±1.98 (P =0.157) in the cuff, respectively. None of the patients experienced side effects throughout the therapy. Demographic and clinical data are depicted in Table 1. Treatment outcomes are demonstrated in Figure 1. Pouchoscopy images before (A) and after (B) mesalamine suppository therapy are shown in Figure 2.2815_A Figure 1. mPDAI symptom sub scores for 8 patients before & after Mesalamine suppository.2815_B Figure 2. Pouchoscopy before (A) and after (B) mesalamine suppository therapyConclusion: Our study suggests that Mesalamine suppository appears to be effective and safe in treating CD of the pouch.2815_C Figure 3. Demographic and Clinical Characteristics in patients with Crohn's Disease (CD) of the Pouch.