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Stronger or weaker? Apriso vs. Lialda vs. Asacol

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Ulcerative Colitis
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Posted 1/25/2010 5:59 PM (GMT 0)
Hi all,

My insurance increased co-pay for Asacol but reduced the cost of Lialda and Apriso. I'm just now starting Apriso but I'm suspicious about it.

If you look at the Asacol and Lialda information, both drugs have been tried at varying dosages, with the higher dosages effective at inducing remission. If you look up Apriso, however, it's only ever been tested at the standard dose, and no trials were done to see whether it induces remission.

Given that the company behind Apriso only tested to see whether it maintains remission, whereas the other two have been tested (and proven effective) in inducing remission, is it fair to assume that Apriso is an inferior mesalamine drug?

I have active colitis so a drug that only maintains remission is worthless to me.
Posted 1/25/2010 6:07 PM (GMT 0)
Never had any of those induce remission.
Posted 1/25/2010 6:11 PM (GMT 0)
Apriso does have less mesalamine than Asacol and Lialda, but it's forumlated to dissolve so differently that it theoretically is more effective at dispersing the mesalamine in the colon. Now, whether that's really true or not remains to be seen. I'm in a really solid remission using it, but have thoughts that I might need to switch to Asacol during an active flare.

Are you using rectal meds as well? I'd strongly consider asking your doc about adding mesalamine enemas as well. They're extremely effective at treating the part of the colon they reach.
Posted 1/25/2010 6:19 PM (GMT 0)
I actually did start taking Canasa suppository the other day after I thought I was going to lose my mind (10-12 movements per day, two days in a row, mostly in morning). It seemed to help almost immediately and I will definitely continue taking it.

Speaking of that, is there any way to know where your colitis is most active? If it's most active near the rear, then obviously a suppository would work better than oral medication.
Posted 1/25/2010 6:25 PM (GMT 0)
Pretty much, it takes a colonoscopy to determine that. UC starts at the rectum and moves upwards, and the most distal part of the colon is also the last to heal. Oral meds have a tough time treating the far reaches of the colon. If your UC is at all active up the left side, the enema will do a better job than the suppository, because it reaches much further up.
Posted 1/26/2010 2:55 AM (GMT 0)
Interesting that you raised this Q right now! The ccfa.org Website homepage has a link to a new study reporting results of 2 different dosages of Asacol HD on patients. I myself checked on Apriso in an Rx insurance formulary over the weekend & found it to be cheaper than my brandname Colazal! I'm assuming that the lower no. of pills in the daily standard dose (compared to older oral 5-ASAs) is what reduces the price of Apriso overall. I haven't perceived it as "inferior"-- as Fruitgirl says, it was designed to disperse differently than the older meds. However, Salix rushed it to market to compete with Lialda, I do believe. What concerns me is kidney tolerance over time-- because that's where high dosages of 5-ASAs can cause harm. Have you been scoped? / Old Hat (30 yrs with left-sided UC; presently in remission taking brandname Colazal-- the generic made me sick)
Posted 1/28/2010 11:25 PM (GMT 0)
Yeah I've had 3 colonoscopies and I have pancolitis. I thought I was gradually getting better after a couple days of suppositories but I got a darn cold and now I'm going too the bathroom frequently again.
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