The Case for Using 5-Aminosalicyclates in Crohnʼs Disease

Abstract

Mesalamine has a well-established role in the management of ulcerative colitis. However, its role in the management of Crohn's disease (CD) is less clear. Studies evaluating its therapeutic value in CD have produced both positive and negative results. Meta-analyses have not clarified the situation, possibly because they have combined studies of different design. This debate critically examines the evidence for and against the use of mesalamine in CD.

Changes in Clinical Characteristics, Course, and Prognosis of Inflammatory Bowel Disease during the Last 5 Decades: A Population-Based Study from Copenhagen, Denmark

“…In CD, significantly fewer patients in cohort 3 (61%) than in cohorts 1 and 2 (approximately 85%) received these drugs. This finding may be a result of the shorter observation time of cohort 3, but it could also reflect a true decrease in the use of 5‐ASAs as the initial or maintenance therapy for CD, given the ongoing debate on its relevance 18–20…”

5-Aminosalicylic acid (mesalazine) use in Crohnʼs disease: A survey of the opinions and practice of Australian gastroenterologists

“…One such debate was published in 2005. [2][3][4] The arguments for and against are mostly not based on solid evidence, and are summarized in Table 3. The responses to the questionnaire in the current study offer insights into why the vast majority of Australian gastroenterologists favor the use of 5-ASA drugs in CD.…”

“…1 However, there has been controversy concerning their use in patients with Crohn's disease (CD). [2][3][4] In all clinical settings, including the treatment of active disease and the maintenance of remission following surgical resection or medical induction, confusion arises from interpretation of the results of randomized placebo-controlled trials that either support or refute the use of 5-ASA, and the uncertainties regarding the applicability of the results for trials of 1 preparation of 5-ASA to another.…”

Advances in therapeutic approaches to ulcerative colitis and crohn’s disease

“…The challenge is translating proportions from clinical trials to individual patients. It is now difficult to justify mesalamine for active ileocolic CD, but a trial of nontoxic treatment may still be preferred for some patients with mild disease, as long as limitations are recognized [5]. After all, the response to placebo is not the same as no treatment at all.…”