Asacol doesn't work for crohn's???

Its so funny because I was going to post about this tomorrow. I just saw my GI and after being on nothing for 6months, after my whole life being on meds, I wanted to get back on asacol. I was on it for 6 years at one point and the rest of my life on pentasa. He said that Asacol is out of the question - that it is proven to not be effective in Crohn's. I see so many people on the forum that are on it and don't understand that if the evidence is out there then why are dr's still allowing their patience to continue on this. Maybe it works for a small amount? I read that Pentasa has almost the same effect as a placebo in studies and this is the in the same family as asacol. Unreal. This was what I was on for most of my life. It makes me pretty upset to be learning to this.

Asacol is used primarily for crohn's colitis when crohn's is affecting the colon, it's targeted to reach and release in the colon and therefore wouldn't have any benefit when it's affecting the small intestines. Doesn't necessarily mean that it will be effective for everyone with inflammation in the colon though, I myself had a severe allergic reaction to one dose of 4 pills within the first hour.

:)

I did have it in my small intestine when I was originally diagnosed by colonoscopy in '06, I am not exactly sure where it is now I have another colonoscopy scheduled for the end of the month.
GDen: I have no evidence just passing along what the GI said and was wondering what others had heard. Here is a tip as far as the money goes if you think it is working for you, if you have insurance copays, I don't know how much you are taking but if you are only taking 4 a day ask the Dr if he would up your prescription to 12 a day, then to have a 30 day prescription filled would actually last you 90. My old GI originally filled mine for 12 a day to get into remission but he left it at 12 so that if I got sick again he wouldn't have to call in and change the dose every time. Your co-pay is for a 30-100day supply right? mine was so when I called and ordered it by phone I got 1200 pills for $100, or when I went in to pick it up at the pharmacy it was 360 pills for 30 days. If I was only taking 4 a day $30 lasted 3 months. The insurance company never said anything.

This may be interesting to some once the results are published, it's a clinical trial to visualise the effect of Pentasa (from what I can see this is the same as Asacol) on Crohns.

http://clinicaltrials.gov/ct2/show/NCT00245505

It claims to be in phase 3, but I'm not sure when that means the results will be out.

Obviously it varies patient to patient, but my son with crohn's colitis had been on Asacol for 3 years with no real relief in symptoms.  During that time we had also tried other medications - Prednisone, Entocort, Flagyl, Pentasa, 6-MP, Lialda and Remicade.  The Prednisone worked, but he started flaring as soon as he came off it.  Remicade worked for awhile, but then it started to only help him for about 3 weeks (he gets a double dose every 6 weeks) and then wear off.  As a last resort before changing anything else, his GI took him off the Asacol and put him on Sulfasalazine.  The change in his symptoms has been remarkable.  He is feeling better than he has in years, and is only having one bowel movement a day.  So, does Asacol work for patients with Crohn's?  I don't know - but it certainly didn't work for my son.  I only wish we had switched sooner.

Take care,

Nancy (son Ben, 15; Remicade, Sulfasalazine, Fisol, Boswellia)

the san diego chapter of the CCFA holds annual educational seminars. it was last year or the year before that 2 doctors there, in separate talks independent of one another, had data from research showing that in crohn's 5-ASA drugs are no better than a placebo. now that is what the data shows. it does not mean that it does not work for some, but basically for the vast majority it did not; however the placebo effect is very very real. from talking to my GI about this, he said most docs use it as it is a tool in the tool box and you gotta try something. i was always on 5-ASA drugs and i too never felt that they did anything for me but drain my bank account.

both doctors did say, and showed data attesting to, that 5-ASA drugs do work for UC. how odd....

5-ASA are mesalamine (sp?) drugs (sulfa derived drugs), like asacol, colazal, pentasa, etc. they all work the same with the same active ingredient, just different fillers and delivery mechanism allowing them to target slightly different areas of the digestive tract.

Well IMO they can say all they want that its a placebo affect, but I can tell you it works very well for me. If I stop the Asacol, then I get sick shortly thereafter. And my Crohns is not in the colon.

Asacol was the first medication they put me on after I was diagnosed with Crohns and it didn't work at all.  I went directly to Pentasa which worked for awhile.  Then Imuran was added to the Pentasa.  Then the Humira replaced the Pentasa, still on the Imuran.  Then the Entocort got added to the Humira and Imuran.  Then that quit working so the Prednisone came into play.  Then the Flaygl . . .  It all just sucks doesn't it??  I'm beginning to wonder if anything will work longer than a year or two?  We must build up immunities against it.  Who knows?

Asacol is considered a topical medication.  That is, it works when it touches the inflammation.   The active medication in Asacol (the 5-ASA) is loaded into an acrylic jacket that dissolves at a certain pH.  This pH is generally found in the colon, not the small intestine.  It is said that there is little systemic absorbtion of Asacol.

Other ASAs work in a similar fashion, but the active ingredient in sulfasalzine is made available by bacterial action.  It is also thought to be a systemically absorbed medication, which is why it helps with ibd-related arthritis among other benefits.

Personally, I had a terrible time with Asacol (for uc) but found a lot of relief from sulfasalazine.

I've been on Asacol for about 7 years, I'm not sure it works though. I had stopped taking all medications and I didn't notice any difference. I then had surgery to remove 18" of bad intestine. I was told by my GI that I would never need surgery, so did Asacol work? I'm still currently on Asacol, my doc wants me to go on Methotrexate or Imuran for maint. meds. I'm still leary as to all of the side effects that go with those. Probably by the time i decide to switch, I'll need another surgery. lol!

I hope this won't be too long a post, but I can't find a way to link to the actual study.

Review article: the evidence base for interventions used to maintain remission in Crohn's disease
129: Aliment Pharmacol Ther. 2008 Jan 1; 27(1): 11-8. Epub 2007 Oct 5. Akobeng AK.
Department of Paediatric Gastroenterology, Booth Hall Children's Hospital,
Central Manchester and Manchester Children's University Hospitals, Manchester, UK.

BACKGROUND: Crohn's disease is characterised by recurrent flare-ups alternating with periods of remission. A number of interventions are currently used in clinical practice to try and maintain remission in Crohn's disease but the evidence base for some of them may be questionable. AIM: To review the available evidence on interventions, which are currently used to maintain remission in Crohn's disease.

METHODS: The Cochrane Library and Medline (Pubmed) were searched for level 1 evidence on specific interventions. Search terms included 'Crohn's disease or synonyms', 'remission or synonyms' and the names of specific interventions.

RESULTS: Azathioprine, infliximab and adalimumab are effective at maintaining remission in Crohn's disease. Natalizumab is also effective, but there are concerns about its potential association with progressive multifocal leukoencephalopathy. Long-term enteral nutritional supplementation, enteric-coated omega-3 fatty acids and intramuscular methotrexate may also be effective but the evidence for these is based on relatively small studies. The available evidence does not support the use of oral 5-aminosalicylates agents, corticosteroids, anti-mycobacterial agents, probiotics or ciclosporin as maintenance therapy in Crohn's disease.

I do actually think the Pentasa I'm taking is having some effect. I've had much less D since starting it just over a week ago, I've not seen any change in pain though.

I also stopped taking iron tablets at the same time though, and the GI doctor I saw at the hospital said iron can cause problems for people with Crohn's and cut my dosage.

From what I saw on the screen at my colonoscopy there was alot of yellow stuff, and blood. The report they gave me said "ulceration". Is that indicative of a type of Crohn's?