Multi-matrix system mesalamine: To use or not to use

OBJECTIVE: To evaluate the role of Multi-Matrix System (MMX) mesalamine in the treatment of ulcerative colitis (UC). DATA SOURCES: Literature was obtained through searches of MEDLINE (1966-October 2007) and a bibliographic review of published articles. Key terms used in the searches included ulcerative colitis, mesalamine, MMX, SPD476, and Lialda. STUDY SELECTION AND DATA EXTRACTION: All English-language articles that were identified through the search were evaluated. All primary literature was included in the review. DATA SYNTHESIS: The standard treatment for the induction and maintenance of remission in patients with mild-to-moderate LIC is aminosalicylate products (mesalamine, sulfasalazine, balasalazide, olsalazine). Current mesalamine formulations are not ideal for long-term treatment due to issues with patient adherence secondary to complex dosing regimens and high pill burden. Clinical studies show that MMX mesalamine achieves clinical and endoscopic remission more frequently compared with placebo or mesalamine enema. Patients receiving MMX mesalamine achieved statistically significant clinical and endoscopic remission when compared with those taking placebo (34.1% vs 12.9%; p < 0.001 with 2.4 g/day vs placebo, and 29.2% vs 12.9%; p = 0.009 with 4.8 g/day vs placebo). Similarly, in another study, significantly more patients achieved remission in the MMX mesalamine groups compared with patients in the placebo group (40.5% vs 22.1% with 2.4 g/day vs placebo; p = 0.01, and 41.2% vs 22.1% with 4.8 g/day vs placebo; p = 0.007). MMX mesalamine is well tolerated, with headache, flatulence, and abdominal pain being the most frequently reported adverse events. CONCLUSIONS: Current evidence supports the use of MMX mesalamine for treatment of mild-to-moderate LIC by demonstrating that MMX mesalamine 2.4-4.8 g daily induces remission. It has the advantage of once-daily dosing regimens with lower pill burden than comparable products and, as an oral agent, may have better patient acceptability compared with topical mesalamine formulations. Therefore, MMX mesalamine is an option in patients with UC. The cost of MMX mesalamine is comparable to that of oral and rectal formulations of mesalamine. Further pharmacoeconomic studies are warranted to examine the cost impact of MMX mesalamine.