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Previous Volume 332:988-992 April 13, 1995 Number 15 Next

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ABSTRACT

Background Ulcerative colitis is largely a disease of nonsmokers. Having found previously that treatment with transdermal nicotine patches and mesalamine (5-aminosalicylic acid) has a beneficial effect on active colitis, we examined the value of transdermal nicotine for the maintenance of remission.

Methods We treated 80 patients with ulcerative colitis in remission with either transdermal nicotine or placebo patches for six months in a randomized, double-blind study. Incremental doses of nicotine were given for the first three weeks to achieve a maintenance dose; most patients tolerated 15 mg for 16 hours daily. All patients were taking mesalamine preparations as maintenance treatment at entry into the study; this treatment was stopped once the maintenance dose of nicotine was achieved. Clinical, sigmoidoscopic, and histologic assessments were made at the beginning and the end of the study, or at relapse. Side effects and serum nicotine and cotinine concentrations were monitored throughout the study.

Results There was no significant difference in the number of relapses between the groups. Twenty-two patients in the nicotine group were prematurely withdrawn from the study, 14 because of relapse and 8 for other reasons, including side effects and protocol violations. In the placebo group, 20 patients were withdrawn prematurely, 17 because of relapse and 3 for other reasons. Among patients using 15-mg nicotine patches, serum nicotine and cotinine concentrations were lower than expected and may reflect poor compliance. Side effects were reported by 35 patients — 21 in the nicotine group and 14 in the placebo group — the most common of which were nausea, lightheadedness, and itching.

Conclusions Transdermal nicotine alone was no better than placebo in maintaining remission of ulcerative colitis, and early withdrawal due to side effects was more common in the nicotine group.

Source Information

From the Department of Gastroenterology, University Hospital of Wales, Cardiff (G.A.O.T., J.R.); Leigh Infirmary, Leigh, Greater Manchester (V.M.); the Departments of Pathology (G.T.W.) and Medical Computing and Statistics (R.G.N.), University of Wales College of Medicine, Cardiff; the Health and Behaviour Unit, Institute of Psychiatry and Maudsley Hospital, London (M.A.H.R.); and the Nicotine Laboratory, Poisons Unit, New Cross Hospital, London (C.F.) — all in the United Kingdom.

Address reprint requests to Prof. Rhodes at the Department of Gastroenterology, Ward A7, University Hospital of Wales, Heath Park, Cardiff CF4 4XW, United Kingdom.

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