The Use of 5-Aminosalicylic Acid in Children and Adolescents With Inflammatory Bowel Disease

Abstract

Background: In ulcerative colitis (UC) 5-aminosalicylic acid (5-ASA) is recommended as primary therapy for mild to moderate disease. Topical 5-ASA has been proven especially effective. In Crohn’s disease (CD) the evidence for a beneficial role of 5-ASA is weak. We investigated the use of topical and systemic 5-ASA therapy in children and adolescents with inflammatory bowel disease. Materials and Methods: Data of patients younger than 18 years, registered between April 2008 and December 2015 in the Swiss Inflammatory Bowel Disease Cohort, were analyzed. Results: Three hundred twenty pediatric inflammatory bowel disease patients were included; 189 with CD and 131 with UC. Over one third of UC patients [51 (39%)] received topical 5-ASA therapy and 43 (33%) received combination therapy during their disease course. UC patients with left-sided colitis or proctitis were more likely to receive topical or combination therapy as compared with patients with pancolitis (P<0.001 and <0.001, respectively). An increase in the use of topical 5-ASA therapy in UC patients was noted over time from 5% to 38%. Forty-seven percent of CD patients were treated with oral 5-ASA during their disease course. The usage was stable over time at approximately 15% to 20%. Conclusions: In recent years a very positive trend showing an increase in topical 5-ASA therapy in children and adolescents with UC has been observed. However topical therapy is still used with relative low frequency, especially in patients with a more extensive disease. Conversely, despite weak evidence supporting 5-ASA use in CD patients it has been frequently prescribed. Physicians should continue to encourage their UC patients to use topical therapy.

Colitis and Crohn’s Foundation (India) consensus statements on use of 5-aminosalicylic acid in inflammatory bowel disease

“…5-ASAs are recommended as first-line therapy for induction and maintenance of remission of mild to moderate UC in children [ 115 , 116 ]. 5-ASA therapy should be used for maintenance indefinitely unless intolerant, as it is highly effective and has a good safety profile.…”

Molecular Modeling of Adsorption of 5-Aminosalicylic Acid in the Halloysite Nanotube

“…The halloysite structure was generated from the atomic coordinates of a slice of a halloysite from previous work [29], with the stoichiometry Al 2 Si 2 O 5 (OH) 4 and chirality (19,0). Periodic boundary conditions were applied to create a periodical crystal structure.…”

“…5-aminosalicylic acid (5-ASA) is an anti-inflammatory drug widely used in the treatment of different diseases, such as Crohn's diseases, chronic bowel ulcerative colitis, and proctitis [1][2][3][4]. The consumption of 5-ASA is a growing market, worth an estimated US$1.5 billion in the USA only [5].…”

“…Halloysite, Al 2 Si 2 O 5 (OH) 4 ·nH 2 O, is a multilayer nanotubular clay mineral resulting from the wrapping of 1:1 layers of kaolinite with dimensions of 500-1000 nm in length and 15-100 nm in inner diameter [23][24][25]. Halloysite nanotubes are common excipients in pharmaceutical products and can modify drug bioavailability.…”

Adsorption of 5-aminosalicylic acid on kaolinite surfaces at a molecular level

“…5-aminosalicylic acid (5-ASA) or mesalazine is well known for its specific anti-inflammatory effect in chronic bowel ulcerative colitis and Crohn's diseases and because it exhibits a chemopreventive effect in colorectal cancer (Hauso et al , 2015; Qiu et al , 2016; Sokollik et al , 2017). Consequently, it has been formulated as the active moiety in the common orally administered commercial products Olsalazine®, Balsalazide® and Sulfasalazine®.…”