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Transdermal Nicotine for Ulcerative Colitis
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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.
Mario Guslandi, MD
Alberto Tittobello, MD
University of Milan; Milan, Italy
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.
- Copyright ©2004 by the American College of Physicians
