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Letters |15 September 1997

Transdermal Nicotine for Ulcerative Colitis: Reply

William J. Sandborn, MD; William J. Tremaine, MD; Richard D. Hurt, MD

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  • Mayo Clinic; Rochester, MN 55905
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IN RESPONSE:
Drs. Mogadam, Ando, and Guslandi and Tittobello raise many interesting points. Dr. Mogadam states that a 30% response (39% for nicotine compared with 9% for placebo) is not clinically meaningful. We strongly disagree. Studies of drugs that we accept as efficacious for ulcerative colitis and that led to U.S. Food and Drug Administration approval had very similar response rates. For example, Asacol (mesalamine, Procter & Gamble, Inc., Cincinnati, Ohio) at 2.4 g/d showed 26% clinical improvement (49% for Asacol and 23% for placebo) [1], and Pentasa (mesalamine, Hoechst Marion Roussel, Kansas City, Missouri) at 4.0 g/d showed 23% treatment success, defined as marked improvement of symptoms (59% for Pentasa and 36% for placebo) [2]. We believe that the 30% beneficial effect of nicotine compares favorably to the effects of these other drugs and is clinically meaningful. We also believe that it is reasonable to define first-line therapy as sulfasalazine, rectal or oral 5-aminosalicylate, and rectal or low-dose oral corticosteroids and to designate other, more toxic therapies (such as high-dose oral corticosteroids, 6-mercaptopurine, and azathioprine) as second-line agents.
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Sandborn WJ, Tremaine WJ, Hurt RD. Transdermal Nicotine for Ulcerative Colitis: Reply. Ann Intern Med. ;127:492. doi: 10.7326/0003-4819-127-6-199709150-00021

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Published: Ann Intern Med. 1997;127(6):492.

DOI: 10.7326/0003-4819-127-6-199709150-00021

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