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Transdermal Nicotine for Ulcerative Colitis
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TO THE EDITOR:
I read with interest the report by Sandborn and colleagues [1] on the efficacy of transdermal nicotine for mildly to moderately active ulcerative colitis. They reported that the highest tolerated dosage of nicotine improved clinical activity but did not induce histologic remission.
I am of the opinion that chronic effects by an intensive exposure to nicotine should be carefully assessed before patients received nicotine therapy in clinical practice. Several N-nitrosamines, such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), are synthesized from nicotine; these carcinogens would increase the risk for cancer [2, 3]. In Sandborn and colleagues' study, the serum levels of nicotine in the patients who received the 22-mg patch consistently exceeded 13 ng/mL. This finding is in agreement with the maximal increment level of nicotine (14.3 ng/mL) seen after patients in another study smoked a cigarette containing 1 mg of nicotine [4]. This would mean that the patients were exposed to as much nicotine as would have been seen had they smoked cigarettes ceaselessly all day long during therapy. To date, patients with such an intensive exposure to nicotine have not been proven safe from an increased risk for cancer.
Current therapy can cause remission in almost 90% of patients with acute ulcerative colitis [5]. Hence, risk for developing cancer is an important factor in determining the long-term prognosis of this disease. I am afraid that the small quality-of-life benefit may not compensate for the latent risk for cancer in patients with such benign disease.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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