One-year investigator-blind randomized multicenter trial comparing asacol 2.4 g once daily with 800 mg three times daily for maintenance of remission in ulcerative colitis
Inflammatory Bowel Disease,  Clinical Article

Hawthorne AB et al. – Once–daily (OD) dosing with Asacol 2.4 g is as safe and effective as three times (TDS) dosing, and secondary analysis confirmed significantly reduced relapse rates. The benefit, however, was clinically borderline and may relate in part to ease of adherence.

Methods
  • An investigator-blind randomized trial was undertaken comparing OD Asacol (three 800 mg tablets) versus one 800 mg TDS in maintenance of remission of UC over 1 year.
  • The primary endpoint was relapse rate, and noninferiority would be concluded if the lower limit of the two-sided 95% confidence interval (CI) of the difference in proportions relapsing (TDS-OD) exceeded -10%.
  • Adherence was measured by tablet counts and self-reported adherence.
  • A subgroup of patients used a bottle cap that recorded all bottle opening events.

Results
  • In all, 213 patients were randomized.
  • In the intention-to-treat (ITT) population, relapse rates were 31% (95% CI 22%-40%) in the OD and 45% (95% CI 35%–54%) in the TDS group.
  • Primary analysis confirmed the noninferiority of OD dosing.
  • Two of the study populations, ITT and per-protocol (PP), showed potential superiority of OD dosing.
  • All measures of adherence showed that it was significantly better in the OD group.
  • Multivariate analysis, however, showed OD dosing was associated with lower relapse risk independently of adherence.

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