Commentary: impact of MMX mesalazine
on health-related quality of life in
A. M. R. Marsh & A. J. Lobo
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield,
mesalazine therapy is associated with improvement in
disease-specific, health-related quality of life (HRQL), as
measured by the short inflammatory bowel disease
questionnaire (SIBDQ), in patients with mild-moderate
active ulcerative colitis (UC) and that this HRQL is
treatment is continued.1
In addition to its central finding, this study adds evidence
of the previously suggested relationship between HRQL and
patient-reported measures of disease activity – including
stool frequency (SF) and rectal bleeding score (RBS).2, 3
Ulcerative colitis carries a significant psychological and
social burden.4, 5Maintaining HRQL is therefore important
in long-term management and increasingly recognised as a
critical end-point in randomised controlled trials in UC.
Patient-reported measures are non-invasive and may be
simple, capturing features of importance to patients.
The authors stressed the correlation between changes
in the SIBDQ and the SF and RBS, suggesting that the
improvements in HRQL are mediated through improve-
ments in bowel symptoms. However, there were signifi-
cant improvements in all domains of the SIBDQ over
the acute phase, although more patients showed an
improvement in the bowel symptoms domain than the
other domains, implying a smaller effect size for these
Interpretation of the data is limited by the lack of a
comparator arm, variable treatment dose in the acute
phase and incomplete data availability (only 103/137 had
interpretable data at the beginning and end of the acute
phase). Multiple statistical comparisons were made and it
is not clear whether appropriate adjustments were made.
Despite its limitations, this study helpfully documents
improvement or maintenance of HRQL with MMX
mesalazine treatment, but cannot confirm that the effect
is due to treatment or its size. This - as the authors indi-
cate - would require a randomised, controlled study.
Declaration of personal and funding interests: None.
1. Solomon D, Yarlas A, Hodgkins P, Karlstadt R, Yen L, Kane S.
The impact of MMX mesalazine on disease-specific health-related
quality of life in ulcerative colitis patients. Aliment Pharmacol
Ther 2012; 35: 1386–96.
2. Bernklev T, Jahnsen J, Asdland E, Marsh AMR, Lobo AJ. Health-
related quality of life in patients with inflammatory bowel disease
five years after the initial diagnosis. Scand J Gastroenterol 2004;
3. Han SW, McColl E, Barton JR, James P, Steen IN, Welfare MR.
Predictors of quality of life in ulcerative colitis: the importance of
symptoms and illness representations. Inflamm Bowel Dis 2005;
4. Taft TH, Keefer L, Leonhard C, Nealon-Woods M. Impact of
perceived stigma on inflammatory bowel disease patient
outcomes. Inflamm Bowel Dis 2009; 15: 1224–32.
5. Wolfe BJ, Sirois FM. Beyond standard quality of life measures:
the subjective experiences of living with inflammatory bowel
disease. Qual Life Res 2008; 17: 877–86.
Aliment Pharmacol Ther 2012; 36: 398-402
ª 2012 Blackwell Publishing Ltd