Treatment of Ulcerative Colitis

Ulcerative colitis is largely a disease of nonsmokers and anecdotal reports have suggested that smoking and nicotine may improve symptoms (122). Patients with active ulcerative colitis were treated with either nicotine TD or placebo patches for 6 weeks. All patients had been taking mesalamine, and some were also receiving low doses of glucocorticoids. These medications were continued during the study. Incremental doses of nicotine were used and most patients tolerated 15-25 mg/24 h: 17 of 35 patients in the nicotine group had complete remissions, compared with 9 of 37 patients in the placebo group. Patients in the nicotine group had greater improvement in global clinical and histological grades of colitis, lower stool frequency, less abdominal pain, and less fecal urgency. More of the nicotine group had minor side effects (23 vs. 11 in placebo group), and withdrawals owing to ineffective therapy were more common in the placebo group (3 vs. 8).

The value of TD nicotine for maintenance of remission was studied in 80 patients with ulcerative colitis in remission, using either TD nicotine or placebo patches for 6 months (123). Incremental doses were given for 3 weeks to achieve a maintenance dose (most tolerated 15 mg for 16 h daily). All patients were taking mesalamine at study entry, but this was stopped when maintenance nicotine doses were achieved. Twenty-two patients in the nicotine group were prematurely withdrawn from the study, 14 because of relapse and 8 for other reasons, including side effects and protocol violations. In the placebo group, 20 patients were withdrawn prematurely, 17 owing to relapse and 3 for other reasons. Among patients using 15-mg-nicotine patches, serum nicotine and cotinine concentrations were lower than expected, which may have reflected poor compliance. Side effects were reported by 35 patients, 21 in the nicotine group and 14 in the placebo group. TD nicotine alone was no better than placebo in maintaining remission of ulcerative colitis, and early withdrawal because of side effects was more common in the nicotine group.

Nicotine alone was compared with prednisolone in 61 patients with active ulcerative colitis treated with either nicotine TD or 15 mg of prednisolone for 6 weeks (124). Incremental nicotine doses were given for the first 9 days. Of the 43 patients who completed the trial, 6 of 19 in the nicotine group achieved full sig-moidoscopic remission, compared with 14 of 24 with prednisolone. In those who completed this study, nicotine alone appeared to be of only very modest benefit in acute colitis.

Use of TD nicotine in mildly to moderately active ulcerative colitis was investigated (125) in 64 nonsmoking patients with mildly to moderately active ulcer-ative colitis despite the use of medication. These were stratified (on the basis of smoking history, extent of disease, and concomitant therapy) and assigned to daily treatment with TD nicotine (n = 31) at highest-tolerated dose (11 mg for 1 week and then <22 mg for 3 weeks) or placebo (n = 33). At 4 weeks, 39% of those who received nicotine showed clinical improvement compared with 9% who received placebo. Four patients receiving nicotine discontinued therapy because of side effects. At week 4, the nicotine group had trough serum concentrations of 12.3 ± 8.4 ng/mL (nicotine) and 192 ± 95 ng/mL (cotinine). It was concluded that transdermal nicotine at <22 mg/d for 4 weeks was effective in controlling the clinical manifestations of mildly to moderately active ulcerative colitis.

A pilot trial of nicotine TD as an alternative to corticosteroids in ulcerative colitis was reported (126). In ten patients with mild-to-moderate clinical relapses of ulcerative colitis during mesalamine treatment and with a previous history of poorly tolerated steroids, TD nicotine (15 mg daily) was added for 4 weeks. Clinical remission was achieved in seven patients and persisted for up to 3 months after nicotine withdrawal.

A second study (127) investigated long-term effects. Patients with mild-to-moderate clinical relapses of left-sided ulcerative colitis during maintenance treatment with mesalamine were allocated additional treatment with either TD nicotine or prednisone for 5 weeks. The first consecutive 15 patients in each group with clinical and endoscopic signs of remission were followed-up for 6 months, while continuing mesalamine maintenance treatment. Relapses of active colitis were observed in 20% of patients formerly treated with nicotine and 60% of patients in the prednisone group, and relapses occurred earlier in the latter group. As patients with mild-to-moderate active colitis treated with mesalamine plus TD nicotine appeared to suffer fewer relapses than patients treated with mesalamine plus oral prednisone a long-term follow-up was carried out (128). Thirty patients with remission of distal colitis were monitored for 12 months and relapsed patients retreated in a crossover manner. Recurrences were observed in 14 of 15 patients initially treated with steroids and in 7 of 15 subjects who received TD nicotine.

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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