Review article: delivery and efficacy of topical @entity2983 ( XXXX ) therapy in the treatment of @entity31 .

@entity3504 @entity31 @entity2983
BACKGROUND: The use of topical therapy in the treatment of @entity31 has declined in recent years despite evidence of good efficacy. AIMS: To review US prescription trends for @entity2983 ( @entity3504 ) since the US approval of Asacol extended-release oral @entity2983 ( @entity2983 ) in 1992; to estimate the optimal level of @entity3504 exposure in the distal colon; to determine factors influencing distal colonic exposures; and to compare the effectiveness of different @entity3504 formulations (oral, topical suspension, foam, suppositories) in clinical trials. METHODS: Review of clinical trials, physiologic studies and prescription trends of various @entity2983 formulations for treatment of distal @entity31 . RESULTS: Between 1992 and 2009, prescriptions for oral @entity2983 increased sixfold, whereas topical suspensions declined by 10%. In clinical trials, topical therapy resulted in higher remission and clinical response rates than oral therapy, with trends to earlier improvement. The mucosal concentrations of @entity3504 achieved by topical agents in the distal colon were up to 200-fold higher than those achieved by oral administration alone. Despite active colitis, over 40% of a topically administered 4 g @entity3504 suspension (equal to 1.6 g) reached the sigmoid colon. This likely represents a therapeutic exposure of @entity3504 . Although topical therapies are less convenient than oral medications, treatment algorithms have failed to take into account quality of life improvements resulting from more rapid and complete treatment response. CONCLUSIONS: Topical @entity2983 therapy is superior to oral therapy in distal @entity31 for both therapeutic response and drug delivery. Practice patterns should be re-evaluated in light of this information.
