A BE Study Comparing Mesalamine 400 mg to ASACOL® 400 mg in Patients With Mild To Moderately Active Ulcerative Colitis

This was a multi-center, randomized, parallel-groups comparison of two mesalamine products for treatment of ulcerative colitis. Patients were randomly assigned in an optimized 2:2:1 ratio to MDRT 2.4 g/day, Asacol 2.4 g/day, or placebo. The study was partially blinded due to the difficulties associated with creating placebo that matched both MDRT and Asacol; the placebo matched the MDRT formulation. Placebo groups served as control in the parallel group comparison between MDRT and Asacol. Patients were treated for 6 weeks after randomization and followed through Day 56, which was considered of sufficient length to accommodate any safety issues and to assess efficacy based upon prior clinical trials of mesalamine in patients with mild to moderate active UC as described in the introduction

Inclusion criteria

Adults with newly diagnosed ulcerative colitis or with relapse following prior treatment and who met all the following criteria were eligible for participation in the study:

• IRB approved consent form signed and dated prior to any study-related activities
• Male or, if female, had undergone sterilization (hysterectomy or bilateral tubal ligation), was post-menopausal (defined as 1 year without menses) or has a negative pregnancy test at screening and, if heterosexually active, had used and agreed to continue to use: double-barrier method of contraception (condom and spermicide), oral or patch contraceptives, intrauterine device, or was in a monogamous relationship with a partner who had undergone a vasectomy.
• 18 years of age or older
• Newly diagnosed with ulcerative colitis or relapsed following prior treatment
• Patient had not taken > 1.6 g/day of mesalamine or equivalent for 14 days prior to randomization
• Disease extending ≥ 15 cm above the anal verge on screening sigmoidoscopy or colonoscopy with confirming biopsy
• Mild to moderate ulcerative colitis, defined as a Disease Activity Index (DAI) score between 4 and 9, inclusive, at study entry, and with a PGA of 1 or 2 and mucosal appearance (determined by endoscopy exam) score of 1 or 2 (mild/moderate)
• Able and willing to have kept a daily diary during the study

Exclusion criteria

• Treatment with topical rectal, oral, or intravenous (IV) corticosteroids within 30 days of screening or immunosuppressives (e.g. azathioprine, 6-mercaptopurine) within the 90 days immediately preceding Screening
• Use of rectal - administered aminosalicylates within 7 days of randomization
• Patient had taken greater than 1.6 g/day of mesalamine or equivalent within 14 days of randomization
• Crohn's disease, ischemic colitis, or disease of bacterial origin
• Known allergy or hypersensitivity to aspirin or salicylate compounds
• History of or laboratory results showing significant hepatic or renal disease or other significant medical condition which in the opinion of the investigator precluded participation in the study based on efficacy/safety assessments
• History of cancer other than basal cell carcinoma within the five years immediately preceding study entry
• In relapse for > 3 weeks prior to the screening visit
• Proctitis below 15 cm from the anal verge
• History of or current gastrointestinal bleeding other than bloody stools associated with ulcerative colitis
• History of bleeding disorder
• Active peptic ulcer disease, history of gastrointestinal obstruction including severe constipation, or anatomic abnormality of the GI tract
• Previous colonic surgery
• History of alcohol or other substance abuse within the year immediately preceding anticipated study entry
• HIV positive
• > 6 bloody stools per day
• Positive stool culture for ova and/or parasites, enteric pathogens including Salmonella, Shigella, Yersinia, and Campylobacter, or positive stool assay for C. difficile toxin
• Pregnant or breast feeding
• Used an investigational drug in the 30 days prior to randomization
• BUN or serum creatinine levels of 1.5 times the upper limit of normal (ULN) or liver enzyme levels > 2 times the ULN