Once-daily versus multiple-daily mesalamine for patients with ulcerative colitis: a meta-analysis

Journal of Digestive Diseases, 03/27/2012

Once–daily (OD) mesalamine is as effective and has a comparable safety profile as multiple–daily (MD) regimens for the maintenance treatment of ulcerative colitis (UC), and is even more effective for inducing remission in active UC.


  • Electronic databases up to July 2011 were searched for related studies evaluating the efficacy of OD vs MD for treatment of UC.
  • Only randomized controlled trials (RCTs) were considered eligible.
  • Remission rates or relapse rates were analyzed using intention-to-treat (ITT) and per-protocol (PP) analysis.
  • Pooled relative risk (RR) and 95% confidence interval (CI) were calculated.
  • Publication bias was assessed with a funnel plot.


  • Overall 10 RCTs including 9 full-text manuscripts and one abstract met the inclusion criteria.
  • OD dosing of mesalamine was shown to be as effective as MD dosing for the maintenance of clinical remission in patients with quiescent UC (RR = 1.00, 95% CI 0.89–1.12) by ITT analysis.
  • For active UC, a mild but significant benefit was achieved by OD dosing compared with MD dosing (RR = 0.80, 95% CI 0.64–0.99).
  • Total adverse events were similar using OD and MD mesalamine in quiescent UC (RR = 1.06, 95% CI 0.93–1.20).
  • Compliance with OD was slightly better than with MD (RR = 0.92, 95% CI 0.82–1.03).

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