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What are mesalamine meds supposed to do in reality?

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Ulcerative Colitis
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Posted 4/2/2013 7:46 PM (GMT 0)
I've had UC for I think 3 years now and have yet to find medication that suits me. I've tried Asacol (but only for a few weeks), Colazal (couple months) and Apriso (3+ months) and none of them worked for me it seems.

How are they supposed to affect UC? Just not be as severe of a flare when you do flare up while on them? Or are they supposed to prevent any symptoms flat out? Or just not happen as often?

Apriso is the longest I've taken at 3-4 months now but I just started getting bleeding again this past weekend so wondering what the deal is with the meds. Maybe I'm expecting too much from them?
Posted 4/2/2013 7:49 PM (GMT 0)
I believe the only thing they really do is be an anti-inflammatory, which is good for UC. I think their effects on UC vary widely from individual to individual. Some attain remission, some get worse, and everything in between.
Posted 4/2/2013 7:59 PM (GMT 0)
I agree w/ Gary. Individual result vary. IBD varies in severity too. Anti-inflammatory is good. For some this keeps symptoms down, for others is may provide a window to permit mucosal healing, with more remission-like result.
Posted 4/2/2013 8:03 PM (GMT 0)
They are supposed to get you into remission and keep you there. They get rid of the inflammation.
Posted 4/2/2013 8:07 PM (GMT 0)
Your immune system is attacking your large intestine and that causes inflammation. The meslamine is designed to counter that inflammation (well assuming the anti-inflammatory is enough to fully counteract your immune system's attack that is). If the meslamine isn't enough, then there are other, stronger meds that take your immune system down a notch or two (immunosuppressants like 6mp/imuran).

Generally, there are three categories in clinical studies for a medication. There are those who achieved remission and exhibit no symptoms after taking the medication being studied. There are those who achieved partial-remission which is an improvement in their symptoms, but symptoms remain to some degree after taking the med. And then there are those who are medicine-refractory which means there was no improvement in their symptoms from the medication studied.

A clinical study for most uc medications would read something like this, 20-35% of people achieve remission, 40-50% achieve partial-remission, and the remainder are medicine-refractory (usually the smallest % by far). We all aspire for remission but the statistics say we all won't achieve it. I know I've been chasing the hope of remission a while now...
Posted 4/2/2013 8:09 PM (GMT 0)
GidHike, if you're not using any rectal meds you are missing a big opportunity to really affect the outcome. UC starts in the distal colon - the oral meds really don't get there. You need rectal meds to really make a difference. Ask your DR for rectal mesalamine.
Posted 4/2/2013 8:21 PM (GMT 0)
Mesalamine is like a "soothing lotion" to the lining of the colon -- it is meant to calm inflammation. With mild inflammation there is a positive feedback loop, meaning that having inflammation in your colon can cause the body to continue attacking the lining of the colon, leading to more inflammation, etc etc. That's why (in some people) prednisone can induce remission that lasts after you stop the prednisone: prednisone calms down the inflammation enough that the lining can heal and therefore the body stops attacking the colon. Likewise, that is why mesalamine can induce "partial remission" (inflammation is decreased because mesalamine "soothes" the lining) or it can also induce full remision (inflammation is decreased, body stops attacking lining, colon heals completely = full remission).
Posted 4/2/2013 8:33 PM (GMT 0)
ya, what they said :-)
Posted 4/2/2013 9:02 PM (GMT 0)
What mesalamines are supposed to do, it is supposed to reduce inflammatory metabolites produces in the process of inflammation through arachidonic acid pathway. Exact mechanism is not known, and hence the only policy that the GIs use is trial and error. It works with you, great. It doesn't, they put you on anti-TNFs or in future on Anti-JAKs.
Posted 4/2/2013 9:13 PM (GMT 0)
The one thing everyone is missing is that 100% of the time they help empty out the piggy bank. As others have stated though I would add in the rectal meds for a few days at least to see if that puts you over the top and on your way to remission.
Posted 4/2/2013 9:18 PM (GMT 0)
'The one thing everyone is missing is that 100% of the time they help empty out the piggy bank"

if they perform as designed, why is that an issue ?
Posted 4/3/2013 3:47 PM (GMT 0)
Because we are being ripped off. It is this mindset that if they work and it is health related than no price is too high. Well I'm sorry I have to disagree with such a mindset that just because something is health related that cost competition and fair pricing is something that should just be thrown out the window. We are dealing with something that boils down to very old technology and the fact that they can continue to have a chemist come in a switch around a few molecules and file a new patent so a pharm company can continue to reap billions of dollars from us over the next 20 plus years is criminal in my mind. The pure fact that these pills are less than 10 cents to produce but they continue to charge dollars for is not capitalism in its finest it is a monolopy that is controlled by the priviledged, that is why it is an issue. Too bad that us patients don't have enough backbone to come together to form a large enough group to send a message that we won't tolerate being ripped off by a 50 year old technology.
Posted 4/3/2013 3:58 PM (GMT 0)
Bad Gut - there is plenty of price competition in the oral mesalamine market. You can get generic balsalazide or asulfazine. The fancier and more expensive meds have patented time release coatings that supposedly improve outcomes. I don't know if they do or not, but I have chosen after 10 years of treatment to go generic and I'm doing fine.

In the rectal mesalamine market there are also generics that you can get instead of Rowasa. That was my choice too when I was using rectal meds.
Posted 4/3/2013 4:14 PM (GMT 0)
My issue is my insurance - they don't have any generics on the list. In fact they removed Asacol last year from the insured list and added Lialda. I have been completely fine for years on Asacol. Actually it was about three years ago they removed regular Asacol and only allowed Asacol HD - of course it was more money. Now last year they removed that and added Lialda - of course more money still. And when I take issue with it all they try do is "inform" how much better the new approved drug is and how the suspended matrix is so much more advanced than the previous prescription. So with me, I have an issue with freedom of choice - I don't need an advanced matrix that for some reason the Gov't and Pharms believe is worth somewhere in the trillion of dollars. Man if I got that kind of dough for the financial matrix's I have developed on my job I would be put in jail. I can even argue that peoples net worth is 10x more healthy because of my matrix, but the arguement only works if it is health related. I still say Gov't allowed controlled monolopy, but I have this disease so I have to play their game and be ripped off by it.
Posted 4/3/2013 4:32 PM (GMT 0)
It doesn't make sense to me that your insurance only allows name-brand meds. I thought all insurers wanted generic substitutes if there were available because then they (the insurers) make more profit.

I don't get how your insurance plan's choices are somehow related to a gov't controlled monopoly? If I were you I'd be calling my insurer, or my employer (if it's insurance you get from your job) to complain. Perhaps it's your DR that's writing only name-brand scrips and not permitting substitution?
Posted 4/3/2013 4:42 PM (GMT 0)
uh bg, you could just say "no" !

there are other ways to deal with inflammation -
Posted 4/3/2013 4:59 PM (GMT 0)
Thanks Kaz - maybe you are right that it is the Dr. that is giving my the run around. I think I'm going to contact the insurer directly. Actually the way this seems to go down is I call in my prescription, then I go to pick it up, at that time they tell me they didn't fill it because the insurance won't cover it anymore starting this month or whatever. Then I have to call the Dr. to get a new prescription which all they say they do is contact my insurer to find out which one they will cover. It would be a shame if I find out they cover more but my Dr. only wants to write Rx's for name brands. If that is the case I will have to have a long discussion with the Dr. then decide if that Dr. is the best one for me anymore.
Posted 4/3/2013 5:44 PM (GMT 0)
Bad Gut: That doesn't really sound right about how this is all going down. Please read your health insurance policy YOURSELF, don't take the word of the doctors, pharmacists, or even the insurance company. Your policy should clearly spell out how prescription drugs are covered. Policies are usually in effect for one year in most cases. They cannot change your policy details in the middle of the policy. By this I mean they can't tell you that one drug is covered one month but the next month it is not covered, unless this just happens at renewal time, like December a drug is covered and you start your next year's policy in January and that drug is no longer covered. Unless you have a really weird policy they can't just decide month by month which drugs they are going to cover and which ones they aren't - unless maybe a new drug has entered the market. I have known people in the past who worked for insurance companies and they actually got paid bonuses denying claims for something that was actually covered under the policy. They literally saved millions of dollars per year denying claims that should have actually been covered because people would not fight or did not know they could fight their own insurance company. In most all cases they cannot cover a med one month and then tell you they won't cover it the next month. They are legally obligated to follow whatever the policy states.
Posted 4/3/2013 5:53 PM (GMT 0)
BadGut: what is your insurance?
Posted 4/3/2013 7:00 PM (GMT 0)
United Healthcare using OPTUMRx for prescriptions. I just found out that they do offer many other options under their plan, so I need to do some more research to find out which ones are equivlant and at what costs. Then go back to my Dr. and see why they don't offer me these?


Gary - My prescriptions run typically from about May - May - so it could have been in January when they quit covering the prescription, I just never really took note of it and when. But either way from my point of view it is in the middle of my prescrition.
Posted 4/3/2013 7:52 PM (GMT 0)
In the middle of the prescription doesn't really matter. It is the policy they can't change in the middle of. Assuming your new policy starts in January, they could cover prescriptions one way in December and a different way if your policy changes in January. Policies can change at any time of the year but then they are good for one full year after that. My new policies always start July 1st every year, even though the deductibles go by the calendar year. That means that once I get my new policy July 1st they can't change how they cover things until the next July 1st, when I would get a copy of the new policy. There seems to have been a rash of people on here lately where their insurance companies are trying to get out of paying for meds that they had been covering. They can't do that, plain and simple, unless your policy year has expired and you are now under a new policy year. Sometimes an insurance company will try to intimidate their policy holders into going on a less expensive drug due to the cost when in reality they can't do that if the doctor wrote a prescription for that particular drug. The only thing that really matters is what your policy states and they have to legally go by that, no matter how much they try intimidating you.
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