Transdermal Nicotine for Ulcerative Colitis

Ulcerative colitis (uc) is generally a disease of nonsmokers, who may go into remission if they begin smoking or use nicotine gum (uncontrolled studies). The results of controlled trials of transdermal nicotine (TDN) have been conflicting. The most recent trial, comparing TDN to prednisolone, found that 32% of patients responded to the former vs. 58% to the latter.

To help clarify the potential role of TDN in active UC, Sandborn et al studied nonsmoking patients with active UC, comparing daily treatment with high-dose TDN (up to 22 mg/d ´ 3 weeks) for four weeks vs. placebo. At the conclusion of the trial, 39% of TDN recipients showed clinical improvement compared with 9% of those who received placebo.

During the trial, maintenance treatments chronically employed were not changed. Patients were evaluated by flexible sigmoidoscopy and kept a daily diary of number of stools, amount of rectal bleeding, and a physician global assessment all figured into the disease activity index. Biopsy specimens were assessed before and after the study for disease activity. Although histologic studies did not document improvement from TDN, clinical markers did improve. The authors conclude that TDN is shown effective over short-term therapy in controlling clinical manifestations of mild-to-moderate UC.

Sandborn WJ, et al. Ann Intern Med 1997;126:364-371.