Sulfasalazine
Sulfasalazine is an anti-inflammatory and antibacterial agent used in gastroenterology and rheumatology. Inflammatory bowel diseases (Crohn's disease, ulcerative colitis) are a pressing problem in gastroenterological practice. However, despite certain successes in the development of new methods for diagnosing and treating these diseases, there is still a lack of knowledge in the field of the etiology of the development of inflammatory processes in the intestine. Thus, one of the issues facing scientists that needs to be addressed is increasing the effectiveness of already known drugs. The principle “the new is the well-forgotten old,” as it turns out, also works in relation to pharmacology. Sulfasalazine is far from new on the pharmaceutical front: it has been used for more than 50 years. This drug was synthesized by linking two substances with a nitrogen group: aminosalicylic acid and sulfapyridine. The pharmacological effect of the drug is based on the properties of both of its structural components. Salicylic acid with an amino group in position 5 has anti-inflammatory activity, inhibits the synthesis of inflammatory mediators prostaglandins and neutralizes the effect of cyclooxygenase. Sulfapyridine, in turn, has an antibacterial (bacteriostatic) effect aimed at streptococci, gonococci, diplococci and Escherichia coli. After taking sulfasalazine tablets, approximately 25% of the dose is absorbed in the upper gastrointestinal tract, and due to the portal-biliary circulation of bile acids, more than half of this amount is subsequently returned to the intestine.
As a result, about 90% of the drug enters the colon, which should be considered a very high figure. Clinical trials of sulfasalazine showed the effectiveness of the drug in treating mild and moderate forms of ulcerative colitis (improvement was observed in 64-80% of patients, with a 30% improvement when taking placebo). The same studies demonstrated a dose-dependence of the effect of sulfasalazine, with increasing doses often associated with an increased risk of certain adverse reactions.
Another area of application of sulfasalazine is the treatment of rheumatoid arthritis. This is one of the most common chronic joint diseases, which is based on the inflammatory process. In recent years, the capabilities of rheumatologists in the fight against this disabling disease have increased, incl. thanks to the emergence of new drugs. From this point of view, sulfasalazine can be considered as a “new old” drug with antirheumatic activity again proven in the 80s. The positive effect of this drug is associated with its ability to influence the microflora of the large intestine. Clinical studies have shown 63% success in treating patients with the articular form of rheumatoid arthritis after a year of taking the drug.
Sulfasalazine is available only in tablet form. The drug should be taken after meals. The dose and frequency of administration are determined by the attending physician.
