Cited by 505Inflammatory Bowel DiseaseSmoking Behavior and CessationMicroscopic Colitis

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Transdermal Nicotine for Active Ulcerative Colitis

Pullan, Rupert D., Rhodes, John, Ganesh, Subramanian, Mani, Venk, Morris, John S., Williams, Geraint T., Newcombe, Robert G., Russell, Michael, Feyerabend, Colin, Thomas, Gareth, Sawe, Urbain·1994·New England Journal of Medicine

DOI 10.1056/nejm199403243301202

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Abstract

BACKGROUND: Ulcerative colitis is largely a disease of nonsmokers. Because anecdotal reports suggest that smoking and nicotine may improve the symptoms of the disease, we examined the effect of nicotine as a supplemental treatment for ulcerative colitis. METHODS: We treated 72 patients with active ulcerative colitis with either transdermal nicotine patches or placebo patches for six weeks in a randomized, double-blind study. Incremental doses of nicotine were given; most patients tolerated doses of 15 to 25 mg per 24 hours. All the patients had been taking mesalamine, and 12 were receiving low doses of glucocorticoids; these medications were continued without change during the study. Clinical, sigmoidoscopic, and histologic assessments were made at base line and at the end of the study; symptoms were recorded daily on a diary card, and the clinician made a global assessment. Side effects and plasma nicotine and cotinine concentrations were monitored throughout the study. RESULTS: Seventeen of the 35 patients in the nicotine group had complete remissions, as compared with 9 of the 37 patients in the placebo group (P = 0.03). The patients in the nicotine group had greater improvement in the global clinical grade of colitis (P < 0.001) and the histologic grade (P = 0.03), lower stool frequency (a difference of 1.6 stools daily; P = 0.008), less abdominal pain (P = 0.05), and less fecal urgency (P = 0.009). More patients in the nicotine group had side effects (23, vs. 11 in the placebo group; P = 0.002), the most common of which were nausea, lightheadedness, headache, and sleep disturbance. Withdrawals due to ineffective therapy were more common in the placebo group (3 vs. 8, P = 0.12). CONCLUSIONS: The addition of transdermal nicotine to conventional maintenance therapy improves symptoms in patients with ulcerative colitis.

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Authors: Pullan, R. D., Rhodes, J., Ganesh, S., Mani, V., Morris, J. S., Williams, G. T., Newcombe, R. G., Russell, M., Feyerabend, C., Thomas, G., & Sawe, U.
Affiliations: University Hospital of Wales (GB)
University of Wales (GB)
Princess of Wales Hospital (GB)
New Cross Hospital (GB)
ORCID: Newcombe, Robert G.
Thomas, Gareth
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1994-03-24
Volume: 330
Issue: 12
Pages: 811-815
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199403243301202
OpenAlex: W2315418290
Cited by: 505
References: 28
Citations by year: 2026: 3 · 2025: 6 · 2024: 9 · 2023: 11 · 2022: 10 · 2021: 10 · 2020: 20 · 2019: 9 · 2018: 14 · 2017: 7 · 2016: 5 · 2015: 11 · 2014: 14 · 2013: 15 · 2012: 9
FWCI: 15.58
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Gastroenterology › Microscopic Colitis
Keywords: ulcerative colitis, transdermal nicotine, nicotine patch, smoking, nicotine withdrawal, 5-aminosalicylic acid, maintenance therapy, remission, symptom improvement, adverse effects
MeSH terms: Administration, Cutaneous, Adult, Affect, Colitis, Ulcerative, Cotinine, Double-Blind Method, Female, Humans, Male, Middle Aged, Nicotine, Treatment Outcome, Drug Monitoring

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Transdermal Nicotine for Active Ulcerative Colitis

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