Abstract: 5-Aminosalicylates (5-ASAs) are considered first-line therapy for mild to moderate ulcerative colitis because of their proven effectiveness and safety profile, even in pregnancy. One formulation, however, contains dibutyl phthalate (DBP) in its coating. Though DBP may cause disruptions in utero reproductive development and other congenital abnormalities in rodents, it is unclear whether it leads to physiologically significant fetal abnormalities in humans. The US Food and Drug Administration has changed its classification for DBP-containing 5-ASAs from pregnancy category B to pregnancy category C to reflect a greater degree of uncertainty regarding its effect in humans. For pregnant women with ulcerative colitis, the most important message is to take their inflammatory bowel disease (IBD) medications to prevent disease relapse, which may have the most adverse effects on pregnancy. Physicians should, however, discuss with young women who are taking 5-ASA with DBP the benefits and risks of switching to another formulation of 5-ASA without the DBP compound.
5-Aminosalicylates (5-ASAs) are effective for the treatment of mild to moderate ulcerative colitis and are generally regarded as safe to use, even during pregnancy.
Dibutyl phthalate (DBP) is found in the coating of certain formulations of 5-ASA, and in rodents has been shown to be associated with developmental and congenital abnormalities.
Though phthalates have been shown to be associated with some indicators of reduced masculinization among male fetuses, there is insufficient evidence to prove that it leads to significant harmful effects.
There are several formulations of 5-ASA that do not contain DBP.
Asacol, which contains DBP, is categorized as a pregnancy category C drug, while most other 5-ASAs are in pregnancy category B.
It should be emphasized to pregnant women that taking medications for their inflammatory bowel disease is important because the disease has a strong impact on, not just their health, but the health of their fetus too.
Women of child-bearing age who are taking a DBP-containing 5-ASA should have a discussion regarding the benefits and risks of switching to another 5-ASA, preferably before pregnancy.
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Abstract: A 28-year-old male presented to our office for a consultation about his bloody bowel movements. Colonoscopy revealed moderately active left-sided ulcerative colitis extending from the anal verge up to the mid-descending colon. He was prescribed both oral and rectal 5-ASAs for induction therapy, and is in remission. Appropriate patient education has helped him realize that the best chance of staying in remission is to continue on his medical therapy.
Stool samples should be tested for infectious causes of bloody diarrhea.
Treatment with steroids should be avoided, if possible, as this medication carries the most risk.
In most cases, clinical remission is an acceptable outcome.
In patients newly diagnosed with left-sided ulcerative colitis, if macroscopic evidence of inflammation stops before 35 cm from the anal verge, it is critical to take biopsies in the proximal left colon in normal-appearing mucosa to determine whether a patient with left-sided disease will require dysplasia surveillance.
Patient education at each follow-up visit helps to ensure medication adherence.
We need to help patients understand that UC can be managed with medication, but not cured.
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Brian Bressler, M.D., M.Sc., FRCPC, est professeur adjoint clini-que de médecine dans
le service de gastroentérologie du St Paul's Hospital, Université de la Colombie-Britannique, à Vancouver (Colombie-Britannique).
Résumé Un homme de 28 ans est venu nous consulter pour ses selles sanglantes. La coloscopie a mis en évidence une colite ulcéreuse gauche modérément évolutive, affectant une région allant de la marge de l'anus jusqu'au milieu du côlon descendant. Suite à un traitement d'induction avec des 5-AAS par voie orale et rectale, le patient est maintenant en rémission. Une éducation adaptée au patient lui a permis de réaliser que le meilleur moyen pour lui de rester en rémission était de continuer le traitement médicamenteux. Mots clés : colite ulcéreuse, 5-aminosalicylate, respect du traitement médicamenteux, surveillance de la dysplasie, inflammation du rectum.
Les phtalates dans les 5-AAS : Orienter le choix thérapeutique et minimiser les risques
Teaser:
Geoffrey C. Nguyen, M.D., Ph. D., est professeur de médecine adjoint au Centre for Inflammatory Bowel Disease du Mount Sinai Hospital, Université de Toronto, Toronto (Ontario).
Résumé
Les 5-aminosalicylates (5-AAS) représentent le traitement de première intention pour les patients atteints de colite ulcéreuse (CU) légère à modérée, en raison de leur efficacité prouvée et de leur profil d'innocuité, même pour les femmes enceintes. Cependant, une préparation de 5-AAS possède un revêtement contenant du phtalate de dibutyle (DBP). Bien que, chez les rongeurs, le DBP puisse entraîner des troubles du développement reproducteur et d'autres anomalies congénitales in utero, on ne sait pas si le DBP provoque des anomalies foetales importantes sur le plan physiologique chez les humains. La Federal Drug Administration a modifié la classification des 5-AAS contenant du DBP en les faisant passer de la classe B à la classe C durant la grossesse, afin de refléter le degré plus grand d'incertitude concernant l'effet du DBP chez les humains. Le message le plus important destiné aux femmes enceintes atteintes de CU consiste à prendre les médicaments contre la CU afin d'empêcher une rechute de la maladie, qui pourrait entraîner le plus d'effets indésirables sur la grossesse. Cependant, les médecins doivent discuter avec les jeunes femmes prenant des 5-AAS contenant du DBP des bienfaits et des risques de prendre une autre préparation de 5-AAS sans DBP. Mots clés : phtalates, 5-aminosalicylate, colite ulcéreuse, phtalate de dibutyle, grossesse.
