| Objective:A meta-analysis was conducted on the efficacy and side reactions by randomized controlled trial of frequency of mesalazine in the treatment of ulcerative colitis(UC).The aim is to further understand and evaluate the same dose by once daily(QD)versus twice daily(BID)or three times a day(TID).It can provide guidance for rational administration,improving therapeutic effect and reducting of side effects in 5-aminosalicylic acid(5-ASA)in the treatment of ulcerative colitis.Methods:We searched CNKI,CBM,VIP,Wanfang databases and English database;Cochrane Central Register of Controlled Trials(CENTEAL;Clinical Trials),PubMed,Ovid Medline,Western Biomedical Journal Document Service System(FMJS)and other databases of the Cochrane Library by key words such as mesalazine,randomized controlled trial,5-aminosalicylic acid,Inflammatory bowel disease,Ulcerative colitis,Mesalamine.Randomized controlled trials were screened out from the search results.Meta-analysis of the selected studies was conducted using Review Manage 5.2 provided by Cochrane Assistance Network.Results:A total of 11 randomized controlled trials were included,10 of which were meta-analyzed,including 5 articles on maintainable remission of ulcerative colitis,5 articles on inducer remission in mild to moderate ulcerative colitis.All the trials assessed the remission rate and side effects.The 10 articles included were evaluated by modified Jadad scale for quality assessment.Chi-square test was used to analyze whether there was statistical heterogeneity among the results.Fixed-effect model or random-effect model were used to analyze the treatment effects.Relative risk and 95%CI were used to represent the treatment effects.Conclusion(s):Meta analysis results show that:(1)In inducer remission of patients with mild to moderate ulcerative colitis,there was no significant difference between once a day and many times a day oral administration(RR=1.06,95%CI:0.97-1.17)(the same dosage).It can conclude that the effect of inducer remission of once a day is equivalent to many times a day.(2)In maintainable remission patients with ulcerative colitis in remission period,there was no significant difference between once a day and many times a day oral administration(RR=1.06,95%CI:0.97-1.16)(the same dosage).It can conclude that the effect of maintenance remission of once a day is equivalent to many times a day.(3)Endoscopic remission of mesalazine was observed in patients with ulcerative colitis in inducer remission.There was no significant difference between once a day and many times a day oral administration(RR=1.07,95%CI:0.98-1.17)(the same dosage).It can conclude that endoscopic remission of once a day is equivalent to many times a day in inducer remission.Endoscopic remission of mesalazine in patients with ulcerative colitis in remission period was included 1 research,which could not be meta-analyzed.The study pointed out that at 12 months 64.4%of patients in remission period achieved endoscopic remission by once a day,68.5%of patients in remission period achieved endoscopic remission by many times a day(p=0.3 51),suggesting the endoscopic remission rate in maintenance remission period of once a day is equivalent to many times a day.(4)In inducer remission of mesalazine,67 of 191(35%)patients in the once-a-day group achieved histological remission,while 77 of 189(41%)patients in the three times daily group achieved histological remission.There was no significant difference between the two groups.(5)In the side effect of maintainable remission of patients with ulcerative colitis in remission period,there was no significant difference between once a day and many times oral administration(RR=1.04,95%CI:0.95-1.14)(the same dosage).It can conclude that there is no significant difference in the side effect incidence between once a day and mang times a day in maintainable remission.It suggests that once a day not significantly increase the side effect incidence in maintainable remission of patients with ulcerative colitis in remission period.(6)In the side effect of mesalazine inducer remission in patients with mild to moderate ulcerative colitis,there was no significant difference in the side effect between once a day and mang times oral administration(RR=0.94,95%CI:0.80-1.11)(the same dosage).It can conclude that there is no significant difference in the side effect incidence between once a day and many times a day oral administration(the same dosage).It suggested that once a day oral administration does not significantly increase side effect incidence in inducer remission,and even tends to reduce the i side effect incidence,which requires more researchs to support.Conclusion:In the treatment of ulcerative colitis with mesalazine,there was no significant difference in the efficacy of maintainable remission,inducer remission and endoscopic remission between once a day and many times a day oral administration(the same dosage),and there was no significant difference in the side effect incidence. |
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