Rectal 5-aminosalicylic acid for maintenance of remission in ulcerative colitis

Marshall, John K.; Thabane, Marroon; Steinhart, A. Hillary; Newman, Jeffrey D.; Anand, Anju; Irvine, E. Jan

doi:10.1002/14651858.cd004118.pub2

Cited by 35 publications

(22 citation statements)

References 23 publications

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“…When the disease is limited to left-sided colon, topical therapy with enemas and/or suppositories is very effective in inducing remission in upward of 90% of cases and highly effective at maintaining remission. [47][48][49] However, many patients prefer oral 5-ASA over the topical formulations for ease of administration. In patients with more extensive disease, oral 5-ASAs are used for induction and maintenance of remission.…”

Section: -Aminosalycilatesmentioning

confidence: 99%

Ulcerative Colitis

Feuerstein

Cheifetz

2014

Mayo Clinic Proceedings

252

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Ulcerative colitis is a chronic idiopathic inflammatory bowel disease characterized by continuous mucosal inflammation that starts in the rectum and extends proximally. Typical presenting symptoms include bloody diarrhea, abdominal pain, urgency, and tenesmus. In some cases, extraintestinal manifestations may be present as well. In the right clinical setting, the diagnosis of ulcerative colitis is based primarily on endoscopy, which typically reveals evidence of continuous colonic inflammation, with confirmatory biopsy specimens having signs of chronic colitis. The goals of therapy are to induce and maintain remission, decrease the risk of complications, and improve quality of life. Treatment is determined on the basis of the severity of symptoms and is classically a step-up approach. 5-Aminosalycilates are the mainstay of treatment for mild to moderate disease. Patients with failed 5-aminosalycilate therapy or who present with more moderate to severe disease are typically treated with corticosteroids followed by transition to a steroid-sparing agent with a thiopurine, anti-tumor necrosis factor agent, or adhesion molecule inhibitor. Despite medical therapies, approximately 15% of patients still require proctocolectomy. In addition, given the potential risks of complications from the disease itself and the medications used to treat the disease, primary care physicians play a key role in optimizing the preventive care to reduce the risk of complications.

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Section: -Aminosalycilatesmentioning

confidence: 99%

Ulcerative Colitis

Feuerstein

Cheifetz

2014

Mayo Clinic Proceedings

252

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“…11,25,26 By contrast, there is strong evidence to support oral 5-ASAs for the induction and maintenance of remission in ulcerative colitis. [27][28][29] Similarly, topical 5-ASA therapy has a proven efficacy in the induction and maintenance of remission in ulcerative colitis, particularly for distal disease, 30,31 or as an adjunct to oral 5-ASA therapy for induction of remission for more extensive disease. 32,33 Topical steroids, once popular for treating distal ulcerative colitis, are now considered second line or adjunctive to topical 5-ASAs in ulcerative colitis.…”

Section: Introductionmentioning

confidence: 99%

Steroid dependency and trends in prescribing for inflammatory bowel disease – a 20‐year national population‐based study

Chhaya

Saxena

Cecil

et al. 2016

Aliment Pharmacol Ther

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Section: -Aminosalycilatesmentioning

confidence: 99%

“…The results of a recent meta-analysis indicated that rectal 5-ASA was superior to placebo for inducing symptomatic, endoscopic and histological improvement and remission [54]. Rectal 5-ASA was superior to rectal cortico steroids for inducing clinical improvement and remission [54]. Three randomized controlled trials were conducted to compare the efficacy of intermittent topical 5-ASAs with that of oral 5-ASAs in preventing the relapse of quiescent UC [55][56][57], and two compared rectal combined with oral 5-ASAs [58,59].…”

Section: -Aminosalycilatesmentioning

confidence: 99%

Ulcerative colitis: prevention of relapse

Sakuraba

Hibi

2013

Expert Review of Gastroenterology & Hepatology

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The clinical management of ulcerative colitis (UC) involves first treating the acute symptoms to induce remission, and then successfully maintaining it. Oral 5-aminosalicylic acids are safe and useful for maintaining remission in patients with UC. In terms of adherence, a once-daily form of 5-aminosalicylic acid is superior in maintaining remission as compared with split dosing. Patients at high risk of relapse may be candidates for treatment with thiopurines and/or biologics in the early stages of UC. Calcineurin inhibitors, such as cyclosporine and tacrolimus, are effective for severe, steroid-refractory UC patients. It is suggested that these patients use thiopurines as their maintenance therapy once they achieve remission with calcineurin inhibitors. Recent studies have confirmed that biologics are effective for inducing clinical and endoscopic remission of UC, and thus they may improve long-term prognosis of UC.

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Rectal 5-aminosalicylic acid for maintenance of remission in ulcerative colitis

Cited by 35 publications

References 23 publications

Ulcerative Colitis

Ulcerative Colitis

Steroid dependency and trends in prescribing for inflammatory bowel disease – a 20‐year national population‐based study

Ulcerative colitis: prevention of relapse

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