Comparison of outcomes of continuation/discontinuation of 5-aminosalicylic acid after initiation of anti-tumor necrosis factor-alpha therapy in patients with inflammatory bowel disease

Choi, Youn I; Kim, Tae Jun; Park, Dong Kyun; Chung, Jun‐Won; Kim, Kyoung Oh; Kwon, Kwang An; Kim, Yoon Jae

doi:10.1007/s00384-019-03368-1

Cited by 4 publications

(2 citation statements)

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“…For patients who escalate to biologic therapy, the decision remains whether prior medications should be continued. In regards to 5-ASA medications, adult studies have shown there is no benefit or increased risk of adverse events in patients who discontinue 5-ASA upon biologic therapy initiation (7,(10)(11)(12)(13). A pooled analysis of individual participant data from clinical trials showed that concomitant 5-ASA use was not associated with increased odds of achieving clinical remission, mucosal healing, or biochemical remission in moderate to severe UC (12).…”

Section: Discussionmentioning

confidence: 99%

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Natural History of Pediatric Patients With Crohn’s Disease Treated With Mesalamine Therapy

Young,

Perry,

Malay

et al. 2023

JPGN Reports

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Background: 5-aminosalicylates (5-ASA) are used to treat mild to moderate ulcerative colitis. Despite their lack of efficacy in Crohn disease (CD), they are still used in real-world practice. Additionally, when patients have progressive disease, they may escalate to biologic therapy, at which time 5-ASA may or may not be discontinued. Objectives: The aim of this study is to assess the clinical outcomes of patients started on 5-ASA for the treatment of pediatric CD. The secondary aims were to evaluate the outcomes of those who continue 5-ASA to those who discontinue 5-ASA upon biologic escalation. Methods: We performed a single-center retrospective chart review of pediatric CD patients from 2010 to 2019 who were initially treated with 5-ASA. Demographics, medication and laboratory data, and clinical disease activity were collected. Results: Sixty-one patients were included in the study; the majority had inflammatory CD with ileocolonic involvement. Twenty-four patients were on a concomitant immunomodulator. The majority of patients (85.2%) required escalation to biologics. Thirty-two patients (61.5%) who escalated to biologic therapy continued on 5-ASA. Eighty percent of patients achieved clinical remission at 1 year, and there was no difference between those who continued 5-ASA at time of biologic initiation compared to those who did not continue the medication. Patients who discontinued 5-ASA had an average annual cost savings of $6741. Conclusion: 5-ASA is not a durable monotherapy for the treatment of pediatric CD. Patients who require escalation from 5-ASA to biologic therapy do not benefit from concomitant 5-ASA therapy. Further prospective studies are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

“…In addition, for those patients who start on 5‐ASA and escalate to biologics, there is a subset who remain on 5‐ASA therapy. Recent adult studies have shown there is no additional benefit and no increase in adverse outcomes for patients with IBD who remain on 5‐ASA after escalation to biologic therapy (7,10–13).…”

Section: Introductionmentioning

confidence: 99%

Natural History of Pediatric Patients With Crohn’s Disease Treated With Mesalamine Therapy

Young,

Perry,

Malay

et al. 2023

JPGN Reports

View full text Add to dashboard Cite

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Concomitant 5-Aminosalicylate Therapy in Moderate-to-Severe Ulcerative Colitis Patients Escalated to Infliximab Is Not Beneficial

et al. 2020

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Medication Burden Before and After Prescription of Biologics in Patients with Inflammatory Bowel Disease

Fernandez Milano,

Krieg,

Kostev

2024

JCM

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Background: Biologics are a cornerstone in the treatment of severe cases of inflammatory bowel disease (IBD) and aim to control the disease and improve quality of life. This study investigated changes in nonbiologic medication prescriptions for IBD patients initiating biologic therapy in Germany. Methods: This study used data from anonymized pharmacy records in the German longitudinal prescription (LRx) database and included biologic-naive IBD patients who received their first biologic therapy prescription between 2016 and 2022. Changes in prescription rates and pill counts for nonbiologic medications (corticosteroids, 5-aminosalicylates (5-ASA), proton pump inhibitors, analgesics, immunosuppressants, Vitamin D, iron, and antibiotics) before and after the initiation of biologic therapy were assessed using descriptive statistics, McNemar’s tests, and Poisson regression models, adjusting for age and sex. Results: A total of 29,559 biologic-naive IBD patients were included. Prior to index, 91.2% received at least one nonbiologic medication prescription, where corticosteroids and 5-ASA were the most common. Postindex, the overall prescription rate decreased to 87.7%, with significant reductions in prescriptions observed for corticosteroids, 5-ASA, and immunosuppressants (p-values < 0.001). The mean (SD) pill count dropped from 704 (1712) to 514 (1651), with the largest mean differences (95% CI) having been for corticosteroids (−77.9 [−80.3 to −75.5]), 5-ASA (−61.6 [−65.2 to −58.1]), and immunosuppressants (−55.0 [−57.5 to −52.6]). Older patients tended to have greater decreases in pill counts for corticosteroids and 5-ASA, while males showed statistically significant reductions in pill count for immunosuppressants compared with females. Conclusion: This study demonstrates that the prescription of nonbiologic medications significantly decreased after biologic therapy initiation. The use of biologics may therefore lead to improved disease management and potentially better patient outcomes.

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Comparison of outcomes of continuation/discontinuation of 5-aminosalicylic acid after initiation of anti-tumor necrosis factor-alpha therapy in patients with inflammatory bowel disease

Cited by 4 publications

References 40 publications

Natural History of Pediatric Patients With Crohn’s Disease Treated With Mesalamine Therapy

Natural History of Pediatric Patients With Crohn’s Disease Treated With Mesalamine Therapy

Concomitant 5-Aminosalicylate Therapy in Moderate-to-Severe Ulcerative Colitis Patients Escalated to Infliximab Is Not Beneficial

Medication Burden Before and After Prescription of Biologics in Patients with Inflammatory Bowel Disease

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