LETTER
Transdermal Nicotine for Ulcerative Colitis
Mario Guslandi, MD, and
Alberto Tittobello, MD
15 September 1997 | Volume 127 Issue 6 | Page 492
TO THE EDITOR:
We read with great interest the paper by Sandborn and colleagues [1] on transdermal nicotine for ulcerative colitis. In agreement with their data, we also reported that transdermal nicotine, when added to mesalamine, induces clinical alleviation of mild to moderate ulcerative colitis [2]. In fact, nicotine patches allowed most patients with a history of poor tolerance to corticosteroids to avoid prednisone therapy [2]. Although if administered alone, transdermal nicotine seems less effective than oral steroids in active disease [3] and no better than placebo as maintenance treatment [4], we also observed that patients who responded to nicotine were still in clinical remission several weeks after nicotine therapy was discontinued (the previously ongoing maintenance treatment with mesalamine was continued). We also studied patients who had mild to moderate clinical relapses of left-sided ulcerative colitis during maintenance treatment with 1 g of mesalamine twice daily. These patients were randomly allocated to 5 weeks of additional treatment with either transdermal nicotine (15 mg/d) or prednisone (initial dosage, 30 mg/d for 1 week; the dose was then tapered by decreases of 5 mg every 5 days).
The first consecutive 15 patients per group with clinical and endoscopic signs of remission were followed for 6 months while receiving continuous maintenance treatment with mesalamine. Clinical and endoscopic relapses of active colitis occurred in 20% of patients formerly treated with nicotine and 60% of patients in the prednisone group (P = 0.027). Relapses occurred earlier in the latter group. Our results confirm once again that nicotine is beneficial in cases of mild or moderate active ulcerative colitis and indicate that remissions induced by nicotine may last longer than those obtained with oral corticosteroids. The reasons for this phenomenon remain unknown.
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Author and Article Information
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University of Milan; Milan, Italy
1. Sandborn WJ, Tremaine W, Offord KP, Lawson GM, Petersen BT, Batts KP, et al. Transdermal nicotine for mildly to moderately active ulcerative colitis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1997; 126:364-71.
2. Guslandi M, Tittobello A. Pilot trial of nicotine patches as an alternative to corticosteroids in ulcerative colitis. J Gastroenterol. 1996; 31:627-9.
3. Thomas GA, Rhodes J, Ragunath K, Mani V, Williams GT, Newcombe RG, et al. Transdermal nicotine compared with oral prednisolone therapy for active ulcerative colitis. Eur J Gastroenterol Hepatol. 1996; 8:769-76.
4. Thomas GA, Rhodes J, Mani V, Williams GT, Newcombe RG, Russell MA, et al. Transdermal nicotine as maintenance therapy for ulcerative colitis. N Engl J Med. 1995; 332:988-92.
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