balsalazide / Generic mfg. - LARVOL DELTA

Dual-Targeted Therapy of Upadacitinib and Mirikizumab in Clinically Complex Ulcerative Colitis (ACG 2025) - "We present a case of medically resistant ulcerative colitis successfully treated with the combination of upadacitinib and mirikizumab.Case Description/ A 40-year-old woman with a history of left-sided UC diagnosed in 2003 initially achieved clinical remission with mesalamine and then switched to balsalazide...In 2006, she was treated with both mesalamine and 6-mercaptopurine (6-MP) and achieved clinical remission which was sustained for 12 years. After a relapse in Feb 2018 she switched to vedolizumab and achieved deep remission. A subsequent relapse in Aug 2022 prompted a switch to infliximab and reintroduction of mesalamine, however, this was not effective...Combination IL23 inhibitor and JAK inhibitors has been previously reported by our group and others, but not with mirikizumab. We demonstrate efficacy and safety of this unique approach."

Clinical • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

A Review of Reports of Hepatic Failure and Hepatitis to the FDA Adverse Events Reporting System (FAERS) From Inflammatory Bowel Disease (IBD) Pharmacotherapy (ACG 2025) - "Reports of ADRs of all FDA approved IBD therapies including azathioprine, mercaptopurine, methotrexate, tacrolimus, balsalazide, mesalamine, osalazine, sulfasalazine, adalimumab, certolizumab pegol, golimumab, infliximab, natalizumab, vedolizumab, guselkumab, mirikixumab, risankizumab, ustekinumab, tofacitinib, upadacitinib, etrasimod, and ozanimod were reviewed. Tables 1 and 2 below show a truncated list of the reviewed medications, portraying significant ROR in ADR related to hepatitis or hepatic failure.There were 218 reports of hepatitis, and 135 reports of hepatic failure identified in patients with CD and UC. Azathioprine (ROR 4.26), mercaptopurine (ROR 3.08), and methotrexate (ROR 2.58) showed significant ROR for hepatitis in CD. Mercaptopurine (ROR 3.34), tacrolimus (ROR 21.17), and infliximab (ROR 1.86) showed significant ROR for hepatic failure in CD."

Adverse events • Review • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Inflammatory Bowel Disease • Liver Failure • Ulcerative Colitis • ROR1

Unexpected Malignancy: Thyroid Carcinoma in a Pediatric Ulcerative Colitis Patient on Anti-TNF Therapy (ACG 2025) - "At the time of her UC diagnosis, her initial therapy was Balsalazide and 6-mercaptopurine. Due to persistent disease activity, around two years later, she was transitioned to a TNF-i, infliximab 10 mg/kg, and has remained on this therapy...Due to the lack of association between PTC and TNF-i with IBD, we opted to keep her on this therapy. While there is still more to learn about the long-term effects of biologic agents, it is important to monitor for all potential outcomes in this population."

Clinical • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammatory Bowel Disease • Non-melanoma Skin Cancer • Obesity • Oncology • Pediatrics • Skin Cancer • Solid Tumor • Thyroid Gland Carcinoma • Thyroid Gland Papillary Carcinoma • Ulcerative Colitis

Complex Case of Ulcerative Colitis and Hidradenitis Suppurativa Treated With Upadacitinib (ACG 2025) - "Initial treatment included mesalamine and prednisone, later transitioned to balsalazide...Ustekinumab was initiated but discontinued due to sepsis following skin and urinary infections...The evolving treatment approach reflects the need for individualized care, particularly when managing comorbid autoimmune conditions. Ongoing monitoring of inflammatory markers, liver function tests, and fecal calprotectin levels remains critical in optimizing treatment strategies for patients with disease profiles like this one."

Clinical • Anemia • Dermatology • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hidradenitis Suppurativa • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Psoriasis • Rheumatoid Arthritis • Rheumatology • Septic Shock • Ulcerative Colitis • Urology

Not Just a Flare: Diffuse Large B-Cell Lymphoma in a Young Patient With Ulcerative Colitis (ACG 2025) - "This case highlights such an occurrence in a young UC patient and aims to raise awareness of this uncommon but serious complication.Case Description/ A 21-year-old male with a one-year history of UC treated solely with balsalazide presented with six months of worsening left-sided abdominal pain and hematochezia...Although lymphoma is more frequently linked to Crohn's disease and immunosuppression, this case underscores the need for vigilance in UC patients presenting with atypical or severe symptoms. A broad diagnostic approach and timely intervention are essential, even in the absence of conventional risk factors, to improve outcomes in such rare but aggressive malignancies.Figure: Figure 1: Large friable partially obstructing mass in the proximal descending colon"

Clinical • B Cell Lymphoma • Colorectal Cancer • Crohn's disease • Diffuse Large B Cell Lymphoma • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • High-grade B-cell lymphoma • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Bowel Disease • Lymphoma • Non-Hodgkin’s Lymphoma • Solid Tumor • Ulcerative Colitis

A CASE OF DISSEMINATED HISTOPLASMOSIS MIMICKING HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (CHEST 2025) - "CASE PRESENTATION: A 72-year-old male with Crohn's colitis and RA on methotrexate, infliximab, and balsalazide presented to the emergency department with generalized weakness, intermittent confusion, fever, and cough for several days prior to presentation...Aspergillus galactomannan and (1,3)-beta-D-glucan returned positive, and he was transitioned to antifungal coverage with continuation of acyclovir, which was initiated due to whole blood herpes simplex-1 virus positivity...Treatment was changed to only liposomal amphotericin B for disseminated histoplasmosis, including meningitis found on repeat CSF studies, before transitioning to oral itraconazole after approximately one month of therapy... Immunocompromised patients may suffer from disseminated histoplasmosis. Given widespread end-organ effects, providers should have a high index of suspicion for HLH in patients with disseminated histoplasmosis and pancytopenia. Appropriate testing, work-up, and treatment is..."

Clinical • CNS Disorders • Cough • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hemophagocytic lymphohistiocytosis • Herpes Simplex • Immunology • Infectious Disease • Inflammatory Arthritis • Rare Diseases • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • Thrombocytopenia • IL2

Balsalazide-Derived Heterotriaryls as Sirtuin 5 Inhibitors: A Case Study of a Reversible Covalent Inhibition Strategy. (PubMed, Molecules) - "Based on our own optimized balsalazide-derived sirtuin 5 inhibitors, this work presents a systematic investigation of the inhibitory effects of derivatives with moieties that were guided by docking experiments to target the nicotinamide ribose vicinal hydroxy groups of the essential co-factor NAD+ via reversible covalent binding to potentially enhance their potency. The (S)-configured cyanomethyl derivative 50 with an IC50 of 27 µM emerged from our synthesized library of compounds as the most potent functionalized inhibitor and lies in a similar potency range to other established sirtuin 5 inhibitors. Our findings offer a deeper insight into the structure-activity relationships of our balsalazide-derived heterotriaryl-based sirtuin 5 inhibitors and thus could provide an avenue for further optimizations in the future."

Journal • SIRT5

Evaluating rat and canine microbiota models for predicting human colonic prodrug metabolism. (PubMed, Eur J Pharm Sci) - "Degradation kinetics of sulfasalazine, balsalazide, and olsalazine were first assessed. When benchmarked against published human in vitro data, rat degradation rates were closely aligned with human values, particularly for sulfasalazine (rat: K = 0.025 min⁻¹; human: K = 0.021 min⁻¹) and balsalazide (rat: K = 0.015 min⁻¹; human: K = 0.009 min⁻¹). These findings highlight rat faecal material as a practical and translationally relevant model for microbiota-sensitive prodrug metabolism, offering a low-impact alternative to invasive sampling and larger animal studies."

Journal • Preclinical

PREVALENCE OF EXTRAINTESTINAL CUTANEOUS MANIFESTATIONS OF INFLAMMATORY BOWEL DISEASE IN NON-WHITE PATIENTS: A RETROSPECTIVE COHORT ANALYSIS (DDW 2025) - " In this retrospective cohort study, we used TriNetX, a healthcare database comprising over 119 million patients, to identify both White and non-White patients with a diagnosis of IBD who were prescribed at least one IBD-specific medication or advanced therapy including: Mesalamine, sulfasalazine, balsalazide, budesonide, azathioprine, methotrexate, 6-mercatopurine, infliximab, certolizumab, golimumab, adalimumab, vedolizumab, ustekinumab, tofacitinib, upadacitinib, risankizumab, mirikizumab, guselkumab, etrasimod, and ozanimod. With the rise of IBD in non-White populations, the representation of CM of IBD in this population is significantly limited, underrecognized, and thus undertreated. Our results reveal increased prevalence of several CM in the non-White IBD patient population. Notably, hidradenitis suppurativa has been shown to be associated with IBD, however our study is one of the first to highlight that it is significantly increased in IBD patients who are..."

Retrospective data • Cognitive Disorders • Dermatology • Dermatopathology • Gastroenterology • Gastrointestinal Disorder • Herpes Zoster • Hidradenitis Suppurativa • Immunology • Inflammation • Inflammatory Bowel Disease • Psoriasis • Varicella Zoster • Vasculitis • Vitiligo

RISK FOR RECURRENT VTE IN IBD PATIENTS ON ANTICOAGULATION FOR JAK INHIBITORS COMPARED TO OTHER THERAPIES (DDW 2025) - "This population was then divided into patients who were prescribed a JAKi (tofacitinib for ulcerative colitis (UC) or upadacitinib for either UC or Crohn's disease) or other IBD-specific medications including: Mesalamine, sulfasalazine, balsalazide, budesonide, azathioprine, methotrexate, 6-mercatopurine, infliximab, certolizumab, golimumab, adalimumab, vedolizumab, ustekinumab, and risankizumab, mirikizumab, guselkumab, etrasimod, and ozanimod. IBD is associated with an increased risk of VTE. The evidence of recurrent VTE for patients with JAKi use is limited. Current disclaimers for JAKi emphasize risks of use in patients with history of VTE."

Clinical • Cardiovascular • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Inflammatory Bowel Disease • Respiratory Diseases • Ulcerative Colitis • Venous Thromboembolism

Mesalazine-Induced Myocarditis in Inflammatory Bowel Disease: A Systematic Review. (PubMed, Cureus) - "In drug-induced myocarditis cases, mesalazine derivatives, including sulfasalazine, mesalamine, and balsalazide, were most frequently implicated. Potential mechanisms underlying mesalazine-associated myocarditis include IgE-mediated hypersensitivity reactions, direct cardiotoxicity, cell-mediated hypersensitivity, or humoral antibody responses to drug metabolites. When treating myocarditis in IBD, whether due to medication or as an extraintestinal manifestation, discontinuing the offending drug and initiating immunosuppressive therapy appear to be the most effective approach."

Journal • Review • Cardiovascular • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

Orally-Administrable Supramolecular Probiotic Capsules Enable Cooperative Colon-Targeted Inflammation Inhibition for Ameliorating Ulcerative Colitis. (PubMed, Acta Biomater) - "Specifically, Clostridium butyricum (CB) was first engineered with protective norepinephrine (NE) coating and then encapsulated by self-assembled gelatin-based nanocomplexes modified with balsalazide and matrix metalloproteinase 2/9 (MMP2-/9)-responsive fibronectin peptides...STATEMENT OF SIGNIFICANCE: This study reports a supramolecular probiotic capsule with nanointegrative hemostatic and anti-inflammatory capacities for ulcerative colitis (UC) therapy, which could be orally administrated and activated in the inflamed colorectal sites. The probiotic capsules enable immediate UC symptom relief while also accelerating mucosal repair and preventing UC relapse in the long-term, offering an approach for UC treatment in the clinic."

Journal • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis • MMP2

A Rapid and Reliable Absorbance Assay to Identify Drug-Drug Interactions with Thiopurine Drugs. (PubMed, Metabolites) - "With purified TPMT on hand and the absorbance activity assay, we confirmed several compounds that inhibit TPMT, and the results were comparable to a mass spectral assay that measured 6-MP methylation. Understanding the impact of co-administered drugs on TPMT activity will improve the safety and efficacy of thiopurine-based treatment regimens."

Journal • Immunology • Oncology

Cytomegalovirus Colitis Mimicking Steroid-Refractory Ulcerative Colitis in an Immunocompetent Elderly Patient (ACG 2024) - "After being diagnosed with ulcerative colitis a few weeks prior, she was discharged on a short course of prednisone...She was started on methylprednisolone and infliximab, and endoscopy was scheduled...She was started on IV ganciclovir and transitioned to oral valganciclovir for 3 additional weeks...She is currently being treated with balsalazide with plans to follow up with repeat colonoscopy in 6 months...The patient's inability to afford mesalamine also emphasizes the role of socioeconomic factors in managing her IBD, potentially impacting treatment outcomes. Figure: Eosinophilic inclusions, large atypical cells with intranuclear inclusion bodies or "owl-eye appearance""

Clinical • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hepatology • Human Immunodeficiency Virus • Immunology • Inflammatory Bowel Disease • Pain • Tuberculosis • Ulcerative Colitis

Interpretable deep learning translation of GWAS findings for drug repurposing in Atrial Fibrillation (AHA 2024) - "Using a deep learning methodology that utilized GWAS and QTL findings, we identified risk genes and repurposing drug candidates for AF."

Atrial Fibrillation • Cardiovascular

Drug-Induced Liver Injury: A Case of Amoxicillin-Clavulanate-Induced Liver Injury (ACG 2024) - "Management includes immediate cessation of the offending agent with supportive care with n-acetylcysteine (NAC) and ursodiol, although there is little evidence to support their use...Case Description/ A 59-year-old male with ulcerative colitis on balsalazide presented with nausea, vomiting, fatigue, jaundice, scleral icterus, and pruritis...Figure: Cholestatic hepatitis with canalicular cholestasis, associated with hepatocellular degeneration and mild portal inflammatory infiltrates, consistent with drug-induced bile metabolism. Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024."

Clinical • Addiction (Opioid and Alcohol) • Cardiovascular • Cholestasis • Fatigue • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Inflammation • Inflammatory Bowel Disease • Liver Failure • Pruritus • Thrombosis • Ulcerative Colitis

Salmonella Colitis Masquerading as Ulcerative Colitis Flare (ACG 2024) - "She was diagnosed with UC 15 years prior and was controlled well on azathioprine and balsalazide without missed doses...Ceftriaxone was switched to ciprofloxacin with resolution of symptoms and discharge...Antibiotic therapy use is reserved for severe disease or those at risk of invasive disease, such as patients with UC. Figure: Coronal View Computed Tomography of Acute Long Segment Descending Colon Colitis"

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Mucositis • Pain • Ulcerative Colitis

Amlexanox reduces new-onset atrial fibrillation risk in sepsis by downregulating S100A12: a Mendelian randomization study. (PubMed, Front Cardiovasc Med) - "Targeting S100A12 identifies five potential small molecule therapeutics: amlexanox, balsalazide, methandriol, olopatadine, and tiboloe. We identified S100A12 as a key gene influencing the new-onset AF in sepsis through immune regulation, presenting considerable diagnostic and predictive value. Notably, amlexanox, by targeting S100A12 emerges as the most clinical relevant intervention for managing new-onset AF in sepsis patients."

Journal • Atrial Fibrillation • Cardiovascular • Infectious Disease • Inflammation • Septic Shock • IL1B • IL6 • S100A12 • TNFA

5-AMINOSALICYLATES FOR PATIENTS WITH ACTIVE OR QUIESCENT CROHN’S DISEASE: AN UMBRELLA REVIEW OF SYSTEMATIC REVIEWS (UEGW 2024) - "One study compared 6-MP to 5-ASA, one study compared AZA to sulfasalazine- the two studies were pooled together in meta-analysisAdultsMaintenance6-MP: 1 mg kg/ d Methotrexate: 10 mg/wk; 76 weeks AZA: 1- 2.5 mg/kg/ d5-ASA: 3g/d; 76 wkOnly two RCTs; no statistically significant difference in the proportion of patients who maintained remission between AZA (1.0 to 2.5 mg/kg/day) or 6-MP (1.0 mg/day) and mesalamine (3 g/day) or sulfasalazine (0.5 g/15 kg/day) therapy.NMAMoja, 2015Oct 2014MEDLINE, EMBASE, the Cochrane library and clinicaltrials.gov25 RCTs (induction =11, maintenance n=14)Budesonide or mesalamine vs placebo or against each other in active or quiescent CDAdultsBothMesalamine: 1 - 4 g/d; 6 wk for induction, 6 mo for maintenanceBudesonide: 3 -18 mg/d; 6 wk for induction, 6 mo for maintenancePlacebo or mesalamine or budesonide in different dosesBudesonide 9mg/d or higher for induction of remission in active mild-to-moderate CD and 6mg/d for maintenance of remission..."

Clinical • Review • Crohn's disease • Gastroenterology • Immunology • Inflammatory Bowel Disease • Pediatrics

RATES OF ESCALATION TO ADVANCED THERAPY IN PATIENTS WITH ULCERATIVE PROCTITIS AT SIX MONTHS, ONE YEAR, AND TWO YEARS POST DIAGNOSIS (DDW 2024) - ") on a non-advanced therapy (mesalamine sulfasalazine balsalazide budesonide). We excluded those on prior advanced therapy (azathioprine methotrexate mercaptopurine infliximab golimumab adalimumab vedolizumab tofacitinib upadacitinib ustekinumab ozanimod)...Anti-TNFs were the most used medication class with infliximab or adalimumab being the most frequently used agents. Our data suggests a mostly benign disease course in patients with UP with a low percentage requiring advanced therapies."

Clinical • Metastases • Gastroenterology • Gastrointestinal Disorder • Inflammatory Bowel Disease • Oncology • Ulcerative Colitis

PARADOXICAL RISK OF RHEUMATOID ARTHRITIS IN INFLAMMATORY BOWEL DISEASE PATIENTS EXPOSED TO TUMOR NECROSIS FACTOR INHIBITORS: A PROPENSITY MATCHED MULTI-NETWORK STUDY (DDW 2024) - "We identified all patients with IBD and stratified them into two cohorts based on treatment case group: IBD patients on anti-TNFs: infliximab certolizumab golimumab adalimumab versus control group: IBD patients on non-anti-TNF IBD specific treatments: mesalamine sulfasalazine balsalazide azathioprine methotrexate 6-mercatopurine vedolizumab ustekinumab tofacitinib upadacitinib ozanimod and risankizumab. ConclusionIn this large retrospective case-control study among IBD patients we did not detect an association between anti-TNF therapy and paradoxical increased risk of RA when compared to IBD patients who received non-anti-TNF advanced and non-advanced IBD therapy. Our results are consistent with TNF-α's role as a major proinflammatory cytokine and subsequent modulation of systemic inflammation by anti-TNF medications."

Clinical • Cardiovascular • Dermatology • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hidradenitis Suppurativa • Hypertension • Immunology • Inflammatory Arthritis • Inflammatory Bowel Disease • Nicotine Addiction • Obesity • Oncology • Psoriasis • Rheumatoid Arthritis • Rheumatology

VISUALIZING HETEROGENEOUS TRAJECTORIES OF SUBJECTS WITH SURGICAL RELAPSE IN INFLAMMATORY BOWEL DISEASE FROM UK BIOBANK GENERAL PRACTICE DATA (CCCongress 2024) - "Additionally, data for the 9 most used IBD prescription medications: budesonide, sulfasalazine, methotrexate, hydrocortisone, balsalazide, olsalazine, prednisolone, azathioprine, and mesalamine was analyzed as well...The majority of patients fell within the states labeled “blue” (azathioprine, sulfasalazine, and prednisone) “red” (mesalamine only) or “purple” (azathioprine, balsalazide, and prednisolone)...We identified three distinct trajectories leading up to surgical relapse. These trajectories show distinctive medication prescription patterns (5-ASA vs. Azathioprine with steroid use), as well as significantly different times to surgical relapse."

Clinical • Heterogeneity • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • CRP

Validation of an Automated Data Collection Method of Inflammatory Bowel Disease Medications in the National Veterans Affairs Healthcare System (AIBD 2023) - "Medication data for specific IBD medications (mesalamine, sulfasalazine, balsalazide, azathioprine, mercaptopurine, methotrexate, cyclosporine, adalimumab, infliximab, golimumab, certolizumab, vedolizumab, tofacitinib, upadacitinib, ozanimod, ustekinumab, risankizumab) was extracted by prescription fill class and CPT codes. In this first study to systematically assess the accuracy of pharmacy records to detect the use of IBD medications in the national VHA dataset, we were able to detect IBD medications with 83% accuracy. Having a validated and accurate method to detect the use of IBD medications will be essential to study IBD in one of the largest national cohorts of IBD patients."

Crohn's disease • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

A Rare Presentation of Cerebral Venous Thrombosis as a Complication of Infantile Inflammatory Bowel Disease in a 17-Month-Old Infant (AIBD 2023) - "She was ultimately discharged on oral steroids, balsalazide, and Lovenox with outpatient rehabilitation...Current ESPGHAN guidelines only recommend thromboprophylaxis with low-molecular weight heparin for adolescents with acute severe colitis and additional risk factors. However, this case highlights the importance of further randomized trials to evaluate the safety and efficacy of thromboprophylaxis in high-risk children with IBD."

Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

CD45 inhibition in myeloid leukaemia cells sensitizes cellular responsiveness to chemotherapy. (PubMed, Ann Hematol) - "Bioinformatics analysis identified genes whose expression was correlated with CD45 expression such as JAK2, ACTR2, THAP3 Serglycin, and PBX-1 genes, as well as licensed drugs (alendronate, allopurinol, and balsalazide), which could be repurposed as CD45 inhibitors which effectively increases sensitivity to cytarabine and ruxolitinib at low doses. Therefore, CD45 inhibition could be explored as a potential therapeutic partner for treatment of myeloid malignancies in combination with chemotherapy such as cytarabine especially for elderly patients and those showing chemotherapy resistance."

Journal • Acute Myelogenous Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia • Oncology • ACTR2 • JAK2 • PTPRC