Prophylaxis of postoperative relapse in Crohn's disease with mesalamine: European cooperative Crohn's disease study VI

Lochs, Herbert; Mayer, Michael; Fleig, Wolfgang E.; Mortensen, Per Brøbech; Bauer, Péter; Genser, Dieter; Petritsch, Wolfgang; Raithel, Martin; Hoffmann, Rainer; Groß, Volker; Plauth, Mathias; Staun, Michael; Nesje, L. B.

doi:10.1016/s0016-5085(00)70208-3

Cited by 283 publications

(153 citation statements)

References 27 publications

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“…One trial from the 1980s demonstrated bene ts from sulfasalazine at doses greater than 3 g daily (239) , but most recent studies have focused on attempts at postoperative prophylaxis with mesalamine. Although early trials have demonstrated bene ts for mesalamine, >3 g daily, at reducing the risk of postoperative recurrence for up to 3 years in subgroups of patients (240) , more recent controlled trials have been less supportive (241,242) . Overall, the ECCO consensus and a North American Pediatric Workshop support a modest overall bene t of approximately 1 in 10 patients (NNT = 10) for mesalamine at delaying / preventing postoperative recurrence (77,238) .…”

Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…Camma and colleagues described in a meta-analysis a risk reduction of 13.1% by mesalamine treatment compared to placebo [41] . A more recent placebo-controlled trial reported that mesalamine did not significantly affect the postoperative course of CD, but some relapse-preventing effect was found in patients with isolated small bowel disease [64] . In summary, 5 ASA is the only treatment with an evidence-based relapse preventing effect after a surgically induced remission and is therefore recommended according to recent guidelines [65] .…”

Section: Postoperative CD (Surgically-induced Remission)mentioning

confidence: 99%

Conventional therapy for Crohn’s disease

Büning

Lochs²

2006

WJG

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Crohn's disease (CD) is a multifactorial disorder of unknown cause. Outstanding progress regarding the pathophysiology of CD has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD over the last years. However, many drugs have not been approved by regulatory authorities due to lack of efficacy or severe side effects. Therefore, well-known drugs, including 5-ASA, systemic or topical corticosteroids, and immunosuppressants such as azathioprine, are still the mainstay of CD therapy. Importantly, biologicals such as infliximab have shown to be efficacious in problematic settings such as fistulizing or steroid-dependent CD. This review is intended to give practical guidelines to clinicians for the conventional treatment of CD. We concentrated on the results of randomized, placebo-controlled trials and meta-analyses, when available, that provide the highest degree of evidence. We provide evidence-based treatment algorithms whenever possible. However, many clinical situations have not been answered by controlled clinical trials and it is important to fill these gaps through expert opinions. We hope that this review offers a useful tool for clinicians in the challenging treatment of CD.

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“…16,17 However, a more recent and much larger European collaborative study did not find overall benefit in the 5-ASA group versus placebo, although a suggestion of benefit in patients with isolated small bowel disease was noted (see Table 2). 18 A subsequent updated meta-analysis also suggests slight benefit. 19 ECCO 2010 guidance states 'High-dose mesalazine is an option for patients with an isolated ileal resection'.…”

Section: Current Issuesmentioning

confidence: 99%