Oral 5-Aminosalicyclic Acid Versus 6-Methylprednisolone in Active Crohn's Disease

Abstract

The response to 5-aminosalicylic acid (5-ASA) in active Crohn's disease was studied in comparison to methylprednisolone in a 24 week randomized double-blind multicentre study. Sixty-two patients were included in the analysis. Thirty were treated with 500 mg 5-ASA qid and 32 with methylprednisolone (starting dose 48 mg for one week, then reduced weekly to 32, 24, 20, 16 and 12 mg with maintenance at 8 mg/day for the remaining 18 weeks). Mean age, earlier surgical intervention, localization of Crohn's disease and extraintestinal manifestations were not different in both groups. The Crohn's disease activity index (CDAI) and the van Hees index were not significantly different in both treatment groups at the entrance examination (median CDAI 232 in the 5-ASA group and 220 in the methylprednisolone group). According to the protocol, treatment was stopped due to insufficient efficacy in 73% of the patients receiving 5-ASA and in 34% of the patients receiving methylprednisolone (x2test P=0.0019). The area under the curve for the CDAl was significantly greater in 5-ASA (median 170) than in methylprednisolone (P≤0.007) (68). Eleven per cent of patients taking 5-ASA and 26% of patients taking methylprednisolone presented relevant side effects to treatment (not significant). It is concluded from these data that 5-ASA at the dose used in this study is not efficient in the treatment of active Crohn's disease. Considering recent studies in ulcerative colitis, a trial using a higher dose is indicated.

The Case for Using 5-Aminosalicyclates in Crohnʼs Disease

“…Four trials have compared delayed‐release mesalamine with conventional corticosteroids. Schölmerich et al21 randomized 62 patients with mildly to moderately active CD (CDAI, 150‐300) to 2 g/d of delayed‐release mesalamine (n = 30) or 6‐methylprednisolone (n = 32) for 24 weeks. Similar to previous experience, the 2‐g dose of mesalamine was inferior to 6‐methylprednisolone (median change in CDAI was significantly higher in the 6‐methylprednisolone group, −151 versus −58; P < 0.001).…”

Mild to moderate Crohn's disease – defining the basis for a new treatment algorithm

“…A number of small trials and one large trial have compared mesalamine with systemic corticosteroids. In the largest study, the German 5‐ASA Study group compared a 2‐g daily dose of mesalamine with 6‐methylprednisolone (48 mg/day tapering to 8 mg) 18 and found that systemic steroid treatment was significantly better than mesalamine at inducing remission of Crohn's disease. In two very small, double‐blind studies, where mesalamine, at doses of 3 g and 4.5 g daily, was compared with prednisone (40 mg/day tapering to 20 mg) 19 and 6‐methylprednisolone (48 mg/day tapering to 8 mg), 20 respectively, rates of remission were not significantly different between mesalamine and steroid treatments at study end‐point.…”

Aminosalicylates for active disease and in the maintenance of remission in Crohn's disease

“…Several studies have compared the ASAs with glucocorticoids. The first of these by Schölmerich et al (21) in Germany randomised 62 patients to have either a conventional treatment regimen with methyl-prednisolone or Pentasa 1 2g/day. The trial lasted 24 weeks; the primary measure of response was a comparison of the proportions of patients in whom treatment failed, which was defined using CDAI-based criteria.…”