Article ; Online: No increased risk of flare in ulcerative colitis patients in corticosteroid-free remission after stopping 5-aminosalicylic acid: A territory-wide population-based study.
Journal of gastroenterology and hepatology
2022 Volume 37, Issue 7, Page(s) 1284–1289
Abstract: Background and aim: Whether 5-aminosalicylic acid (ASA) can be stopped in patients with stable ulcerative colitis (UC) remains unclear. We aimed to examine whether 5-ASA can be safely withdrawn in UC patients who have been in corticosteroid-free ... ...
| Abstract | Background and aim: Whether 5-aminosalicylic acid (ASA) can be stopped in patients with stable ulcerative colitis (UC) remains unclear. We aimed to examine whether 5-ASA can be safely withdrawn in UC patients who have been in corticosteroid-free clinical remission for ≥ 1 year. Methods: This is a retrospective cohort study using territory-wide healthcare database in Hong Kong. Primary outcome was development of UC flare, defined as new corticosteroid use or UC-related hospitalizations within 5 years. UC patients on oral 5-ASA ≥ 2 g daily for ≥ 1 year with C-reactive protein (CRP) < 10 mg/dL and no 5-ASA dosage escalation, UC-related hospitalization or corticosteroid use in the past year were included. Patients on biological agents were excluded. Patients were classified as "stopping" if 5-ASA was withdrawn for ≥ 90 days within follow-up period. We performed multivariable Cox regression models adjusting for demographics, blood parameters and immunosuppressants used. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was reported comparing stopping and continuous-use groups. Results: A total of 1408 patients were included with a median follow-up duration of 41.8 months (interquartile range [IQR]: 17.2-60.0 months). Stopping 5-ASA was not associated with an increased risk of UC flare (aHR 0.91; 95% CI 0.64-1.31; P = 0.620). A higher CRP levels at the time of stopping 5-ASA (aHR 1.15; 95% CI: 1.01-1.30; P = 0.037) were associated with increased risk of flare. Conclusion: Stopping 5-ASA in UC patients in corticosteroid-free remission for ≥ 1 year was not associated with increased risk of flare. Future prospective trials should evaluate the role of stopping 5-ASA in stable UC patients. |
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| MeSH term(s) | Adrenal Cortex Hormones/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal ; Colitis, Ulcerative/chemically induced ; Colitis, Ulcerative/drug therapy ; Humans ; Mesalamine ; Remission Induction ; Retrospective Studies | ||||||||||
| Chemical Substances | Adrenal Cortex Hormones ; Anti-Inflammatory Agents, Non-Steroidal ; Mesalamine (4Q81I59GXC) | ||||||||||
| Language | English | ||||||||||
| Publishing date | 2022-04-06 | ||||||||||
| Publishing country | Australia | ||||||||||
| Document type | Journal Article | ||||||||||
| ZDB-ID | 632882-9 | ||||||||||
| ISSN | 1440-1746 ; 0815-9319 | ||||||||||
| ISSN (online) | 1440-1746 | ||||||||||
| ISSN | 0815-9319 | ||||||||||
| DOI | 10.1111/jgh.15838 | ||||||||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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