Mesalamine in the prevention of endoscopic recurrence after intestinal resection for Crohn's disease

Brignola, C.; Cottone, Mario; Pera, A.; Ardizzone, Sandro; Scribano, Maria Lia; Franchis, Roberto de; D’Arienzo, A.; d’Albasio, G; Pennestri, Daniele

doi:10.1016/0016-5085(95)90059-4

Cited by 194 publications

(98 citation statements)

References 10 publications

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“…Severe endoscopic recurrence was observed in 17% in the mesalazine group and in 38% in the control group. Brignola et al [33] reported on 87 patients randomly receiving mesalazine (Pentasa) 3 g/day or placebo within 1 month after surgery. After a follow-up of 1 year, clinical relapse occurred in 16% in the mesalazine group and in 23% in the placebo group (nonsignificant).…”

Section: Treatmentmentioning

confidence: 99%

Maintenance of Surgically Induced Remission of Crohn’s Disease

Froehlich¹,

Juillerat²,

Pittet³

et al. 2007

Digestion

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At 1 year after a first resection, up to 80% of patients show an endoscopic recurrence, 10–20% have clinical relapse, and 5% have surgical recurrence. Smoking is one of the most important risk factors for postoperative recurrence. Preoperative disease activity and the severity of endoscopic lesions in the neoterminal ileum within the first postoperative year are predictors of symptomatic recurrence. Mesalazine is generally the first-line treatment used in the postoperative setting but still provokes considerable controversy as to its efficacy, in spite of the results of a meta-analysis. Immunosuppressive treatment (azathioprine, 6-mercaptopurine) is based on scant evidence but is currently used as a second-line treatment in postsurgical patients at high risk for recurrence, with symptoms or with early endoscopic lesions in the neoterminal ileum. Nitroimidazole antibiotics (metronidazole, ornidazole) are also effective in the control of active Crohn’s disease in the postoperative setting. Given their known toxicity, they may be used as a third-line treatment as initial short-term prevention therapy rather than in the long term. Conventional corticosteroids, budesonide or probiotics have no proven role in postoperative prophylaxis. Infliximab has not as yet been studied for use in the prevention of relapse after surgery.

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Section: Treatmentmentioning

confidence: 99%

Maintenance of Surgically Induced Remission of Crohn’s Disease

Froehlich¹,

Juillerat²,

Pittet³

et al. 2007

Digestion

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“…2 In Crohn's ileocolitis, 5-ASA was better than placebo in one trial, 2 and was not signi®cantly different from placebo in seven. 3,6,8,10,12,15,17 Third, of seven trials in which recurrence rates in previously operated patients are reported, 5-ASA was better than placebo in six 3,8,9,13,14,16 and worse in one. 4 Other discrepancies emerge when one examines the relationship between duration of remission prior to enrolment and recurrence rate.…”

Section: Discussionmentioning

confidence: 98%

Controlled trial of oral 5‐aminosalicylic acid for the prevention of early relapse in Crohn's disease

Franchis

Omodei

Ranzi

et al. 1997

Aliment Pharmacol Ther

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Background Recent data indicate that 5‐aminosalicylic acid (5‐ASA) is most effective in preventing relapse of Crohn's disease in patients with a short duration of remission before enrolment. Aim To evaluate the efficacy of oral 5‐ASA treatment, started immediately after achieving steroid‐induced remission, in preventing clinical relapses of Crohn's disease. Methods Patients with active Crohn's disease, achieving remission on steroids, were randomized to oral 5‐ASA 3 g/day or placebo, while steroids were tapered over 6 weeks. The trial was terminated after interim analysis showed a slightly higher relapse rate in the 5‐ASA group, and the calculated probability of seeing a statistically significant difference by completing the study was minimal. Results Final analysis included 117 patients (58 taking 5‐ASA and 59 taking placebo; follow‐up 9.2 ± 6.5 months). Cumulative relapse rates at 6 and 12 months were 34% and 58% in 5‐ASA patients and 31% and 52% in placebo patients, respectively (rate difference + 0.095; 95% CI = −0.085– + 0.274). Subgroups analysis showed that 5‐ASA was equally ineffective in patients with ileal, colonic or ileocolonic disease. Conclusions Contrary to previous results, in our study early introduction of treatment with oral 5‐ASA did not prevent relapse in Crohn's disease patients treated with steroids to induce remission.

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“…15 Relatively small trials performed in the 1990s assessed the efficacy of 5-ASAs in reducing postsurgical recurrence and demonstrated efficacy over placebo. 16,17 However, a more recent and much larger European collaborative study did not find overall benefit in the 5-ASA group versus placebo, although a suggestion of benefit in patients with isolated small bowel disease was noted (see Table 2). 18 A subsequent updated meta-analysis also suggests slight benefit.…”

Section: Current Issuesmentioning

confidence: 99%