eHealth: Individualization of Mesalazine Treatment Through a Self-managed Web-based Solution in Mild-to-moderate Ulcerative Colitis

• Published in: Inflammatory bowel diseases Vol. 20; no. 12; pp. 2276 - 2285
• Main Authors: Pedersen, Natalia, Thielsen, Peter, Martinsen, Lars, Bennedsen, Mette, Haaber, Anne, Langholz, Ebbe, Végh, Zsuzsanna, Duricova, Dana, Jess, Tine, Bell, Sally, Burisch, Johan, Munkholm, Pia
• Format: Journal Article
• Language: English
• Published: Oxford, UK Oxford University Press 01.12.2014
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - psychology; Computer-Assisted Instruction; Drug Administration Schedule; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Inflammatory bowel disease; Internet; Male; Medication Adherence; Mesalamine - therapeutic use; Middle Aged; Patient Education as Topic; Precision Medicine; Prognosis; Prospective Studies; Quality of Life; Recurrence; Self Care; Severity of Illness Index; Telemedicine; Young Adult; mesalazine; ulcerative colitis; multimatrix system; inflammatory bowel disease; web-based management
• ISSN: 1078-0998; 1536-4844; 1536-4844
• DOI: 10.1097/MIB.0000000000000199

To individualize treatment with mesalazine for ulcerative colitis relapses through a self-managed, web-based solution to optimize the short-term disease course.MethodsProspective, open-label, web-guided study with 3 months mesalazine therapy among patients with mild-to-moderate ulcerative colitis. Once a week, patients completed the simple clinical colitis activity index (SCCAI) and registered fecal calprotectin (FC) on the web application: www.meza.constant-care.dk. SCCAI and FC were summed and resulted in a total inflammatory burden score (TIBS). Deep remission was defined as SCCAI ≤1; FC = 0, and TIBS ≤1.ResultsA total of 95 patients (62% females; median age 45 yr) were included in the study and allocated 4.8 g mesalazine per day. Of these, 82 (86%) patients were adherent to web therapy, completing 3 months of web-guided mesalazine therapy. Of the 82 adherent patients, 72 (88%) continued mesalazine and 10 (12%) needed rescue therapy. From weeks 0 to 12, patients had experienced a significant reduction in mean SCCAI (4.6 versus 1.6, P < 0.001), mean FC (437 versus 195, P < 0.001), and mean TIBS (6.7 versus 2.4, P < 0.001). Based on TIBS values (≤1), the dose of mesalazine was reduced to 2.4 g in 25% of patients at week 3 in 50% of subjects at week 5 and in 88% of patients at week 12.ConclusionsWeb-guided therapy with mesalazine in mild-to-moderate ulcerative colitis helps to individualize the dose and improve adherence to therapy. The study confirms mesalazine efficacy in mild-to-moderate UC, significantly improving TIBS values in majority of the patients.