Optimised mesalazine therapy reduces ulcerative colitis recurrence across the mild-to-moderate disease spectrum: the IMPACT study.

Authors

Bolette Christophersen, John Fullarton, Rachel West

Published in

Frontiers in gastroenterology (Lausanne, Switzerland). Volume 5. Pages 1874051. Epub Jul 27, 2026.

Abstract

Optimised oral mesalazine therapy (4 or 4.8 g/day depending on the formulation) has been associated with better outcomes than lower doses in mild-to-moderate ulcerative colitis (UC). The aim of this post-hoc analysis of the IMPACT study was to provide a greater understanding of the influence of disease severity on the outcomes in patients with mild-to-moderate UC receiving oral mesalazine.
IMPACT was a Dutch, phase 4, non-interventional, observational, 12-month prospective study that enrolled 151 adult patients with mild-to-moderate UC who received oral prolonged-release mesalazine de novo or had a dose escalation for an active episode (NCT02261636). The current analysis compared the outcomes in patients receiving mesalazine 4 g/day versus 2-3 g/day.
Of 147 patients (median age = 46 years, 47.6% women), 139 (94.6%) received 4 g/day, mostly as prolonged-release mesalazine granules (74.2%). Recurrence was significantly reduced for patients on 4 g/day versus 2-3 g/day (26.6% vs. 62.5%, p = 0.03). There was a trend towards a longer disease-free interval for those on the optimised dose over the 12-month period (mean = 16.8 vs. 12.8 months, p = 0.49). Time to recurrence was similar (p = 0.241) for patients with milder [Ulcerative Colitis Disease Activity Index (UCDAI) scores ≤3] versus more moderately active disease (scores ≥4), with a significantly higher rate of combined oral plus topical therapy in the latter (23.2% vs. 46.1%, p = 0.004). Patients' preferred formulation was granules (68.0%) given once daily (78.7%), with good adherence to all formulations (≥8.5/10, high = 10) irrespective of regimen (p = 0.873).
Optimised mesalazine treatment improved the clinical outcomes in patients across the spectrum of mild-to-moderate UC.

PMID:
42577109
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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