Sulfasalazine vs Mesalamine: Treatment of Crohn’s Disease Remission

What is Crohn’s disease?

Crohn’s disease is a “chronic inflammatory disease” that can harm a person’s quality of life if it is discovered during their formative years. This condition has a significant economic impact, with annual costs ranging from $1.2 billion to $6.1 billion in Canada and the US, respectively. The natural history of Crohn’s disease is uncertain. Some people have quickly progressing illness that necessitates immunomodulators, antitumor necrosis factor medications, and/or surgery. While on the other hand, some do well with little or no treatment.

Sulfasalazine vs Mesalamine

In the past, mesalamine and sulfasalazine were favored as induction agents treating mild to moderately active Crohn’s disease. However, these medicines have fallen by the wayside due to prior meta-analyses that found them to be ineffective.

According to the American College of Gastroenterology, mesalamine is only moderately efficient in treating mild-to-moderate Crohn’s disease. Despite these recommendations, many gastroenterologists continued to prescribe mesalamine for the management of active Crohn’s disease. According to one research, 90% of gastroenterologists were questioned about prescribed mesalamine alone or in combination for active Crohn’s disease. A prior network-meta-analysis (NMA) found that mesalamine is ineffective as an induction agent in Crohn’s disease.

Another study performed to compare the effectiveness of sulfasalazine vs mesalamine, corticosteroids, and budesonide to treat the induction of remission in active Crohn’s disease showed that at dosages more than 2.4 grams/d (high dose), mesalamine was more efficacious than placebo in inducing Crohn’s disease remission. Despite the fact that the evidence for mesalamine was not as robust as for budesonide or corticosteroids, findings suggest that mesalamine might potentially be used as a therapeutic option in patients who choose not to take steroids.

The research published in 2017 in Inflammatory Bowel Disease Oxford Academic Journal concerning the effectiveness of sulfasalazine vs mesalamine in Crohn’s disease remission suggested that sulfasalazine was not shown to be superior to placebo or other comparator agents such as mesalamine, corticosteroids, and budesonide.

Mesalamine and Mesalazine

Oral mesalazine is also known as mesalamine (5-aminosalicylic acid molecule). It is effective in inducing and maintaining remission in patients with mild to severe ulcerative colitis. Mesalazine has a therapeutic effect when applied topically to the sick colonic mucosa.

The exact mechanism of action of mesalamine is unknown, however, it appears to inhibit arachidonic acid metabolism in the colon. COX and lipoxygenase-mediated mucosal inflammation are both inhibited by it.

To limit systemic absorption and maximize medication availability to the inflamed colonic epithelium, a variety of oral mesalazine formulations have been developed with different drug delivery techniques. The bioequivalence of several oral mesalazine formulations is yet unknown.

For the treatment of mild to severe ulcerative colitis, oral mesalazine comes in a variety of forms. The best formulation is one that is tailored to the person and takes into account aspects including illness distribution, effectiveness, side effect profile, pill load, patient preference, and economics of health.

Sulfasalazine and Mesalazine

When we talk about the effectiveness of Sulfasalazine vs Mesalamine, experimental investigations reveal that there is no evidence to suggest that mesalazine is safer than sulfasalazine in the treatment of inflammatory bowel disease (IBD). Pancreatitis and interstitial nephritis appear to be much more frequent with mesalazine, and recommendations on renal monitoring in mesalazine patients may need to be reinforced.

Sulfasalazine vs Mesalamine serious adverse reactions

A study conducted to re-examine Sulfasalazine vs Mesalazine adverse drug reactions on the basis of alleged adverse reaction reports to the Committee on Safety of Medicines suggests that there are significant variances in adverse reaction patterns linked with the use of mesalazine and sulfasalazine. Interstitial nephritis and pancreatitis appear to be important side effects of mesalazine, but blood dyscrasias are more common with sulfasalazine, although only in rheumatoid arthritis patients. Overall, the findings imply that the decision between sulfasalazine and mesalazine in IBD may be more evenly balanced than it appears at first.

Another study conducted to compare adverse reactions of Sulfasalazine vs Mesalamine indicated that mesalazine’s hematological adverse reactions could be worse than sulfasalazine’s.

Sulfasalazine available brands

Some of the brand names of Sulfasalazine are given below:

  • Azulfidine
  • Salazopyrin
  • Salazine
  • Salazopyrin Suppositories (rectal route)

Mesalamine brand names

  • Pentasa
  • Asacol
  • Mesren
  • Mesasal
  • Claversal
  • Delzicol


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