5‐aminosalicylate maintenance is not superior to no maintenance in patients with newly diagnosed Crohn's disease—A nationwide cohort study

Abstract

Background: 5-aminosalicylates (5-ASA) are widely used in Crohn's disease (CD) despite guidelines advising otherwise. We aimed to assess in nationwide study the outcomes of first-line 5-ASA maintenance therapy (5-ASA-MT) compared with no maintenance treatment (no-MT) in patients with newly diagnosed CD. Methods:We utilised data from the epi-IIRN cohort, including all patients with CD diagnosed in Israel between 2005 and 2020. Propensity score (PS) matching was utilised to compare outcomes in the 5-ASA-MT versus no-MT groups.Results: Of the 19,264 patients diagnosed with CD, 8610 (45%) fulfilled the eligibility criteria (3027 [16%] received 5-ASA-MT and 5583 [29%] received no-MT). Both strategies declined over the years; 5-ASA-MT from 21% of CD patients diagnosed in 2005 to 11% in 2019 (p < 0.001) and no-MT from 36% to 23% (p < 0.001). The probability of maintaining therapy at 1, 3 and 5 years from diagnosis: 5-ASA-MT-78%, 57% and 47% and no-MT-76%, 49% and 38% respectively (p < 0.001). PS analysis successfully matched 1993 pairs of treated and untreated patients and demonstrated comparable outcomes of time to: biologic (p = 0.2), steroid dependency (p = 0.9), hospitalisation (p = 0.5) and CD-related surgery (p = 0.1). Rates of acute kidney injury (5.2% vs. 3.3%; p < 0.001) and pancreatitis (2.4% vs. 1.8%; p = 0.03) were higher in the 5-ASA-MT group compared with the no-MT group but after PS matching the rates of adverse events were similar. Conclusion:First-line 5-ASA monotherapy was not superior to no-MT but associated with a slightly higher rates of adverse events, while both strategies have declined over the years. These findings suggest that a subset of patients with mild CD may be offered a watchful waiting approach.

Effect of Bifidobacterium bifidum G9-1 on the Intestinal Environment and Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D)-like Symptoms in Patients with Quiescent Crohn’s Disease: A Prospective Pilot Study

“…The characteristics of the patients including age, sex, BMI, disease duration, current medications, prior surgery, CRP level and CD activity index are presented in Table 1. Six of 11 patients had been treated with 5-ASA although 5-ASA is currently becoming no more a treatment for CD [16]. Although 10 of 11 patients had undergone elemental diet, no significant relationship has been confirmed between elemental diet and IBS-D-like symptoms in qCD patients in our previous research [10].…”

Interventional inflammatory bowel disease: current and future practice

“…Burgeoning biologic and small molecule pharmaceutical therapies have substantially increased, extending well beyond antitumor necrosis factor. Despite more available therapies and improved access to these drugs, programmatic treatment plans may commonly be disrupted due to medication nonadherence, financial barriers, patient or provider knowledge gaps, and other complexities that exist with delivering care for patients with IBD [3][4][5][6][7]. For these reasons, in conjunction with the rising incidence of complicated and medically refractory IBD phenotypes, complications will continue to be prevalent.…”

Editorial: Why are patients with Crohn's disease still treated with 5‐aminosalicylates?

“…In a recent article, Atia and colleagues demonstrate, that it may in fact be just as good to use a watchful waiting approach 5 . Using data extracted from nationwide patient registries, the group compared patients with CD, that were treated with 5‐ASA as their first maintenance treatment following diagnosis with a propensity‐score matched group of patients receiving no maintenance therapy.…”