Rectal 5-aminosalicylic acid for maintenance of remission in ulcerative colitis

Abstract

The limited data available suggest that rectal 5-ASA is effective and safe for maintenance of remission of mild to moderately active distal UC. Well designed randomized trials are needed to establish the optimal dosing regimen for rectal 5-ASA, to compare rectal 5-ASA with rectal corticosteroids and to identify subgroups of patients who are more or less responsive to specific rectal 5-ASA regimens. The combination of oral and rectal 5-ASA appears to be more effective than either oral or rectal monotherapy for induction of remission. The efficacy of combination therapy for maintenance of remission has not been assessed and could be evaluated in future trials.

Ulcerative Colitis

“…When the disease is limited to left-sided colon, topical therapy with enemas and/or suppositories is very effective in inducing remission in upward of 90% of cases and highly effective at maintaining remission. [47][48][49] However, many patients prefer oral 5-ASA over the topical formulations for ease of administration. In patients with more extensive disease, oral 5-ASAs are used for induction and maintenance of remission.…”

Steroid dependency and trends in prescribing for inflammatory bowel disease – a 20‐year national population‐based study

“…11,25,26 By contrast, there is strong evidence to support oral 5-ASAs for the induction and maintenance of remission in ulcerative colitis. [27][28][29] Similarly, topical 5-ASA therapy has a proven efficacy in the induction and maintenance of remission in ulcerative colitis, particularly for distal disease, 30,31 or as an adjunct to oral 5-ASA therapy for induction of remission for more extensive disease. 32,33 Topical steroids, once popular for treating distal ulcerative colitis, are now considered second line or adjunctive to topical 5-ASAs in ulcerative colitis.…”

Ulcerative colitis: prevention of relapse

“…The results of a recent meta-analysis indicated that rectal 5-ASA was superior to placebo for inducing symptomatic, endoscopic and histological improvement and remission [54]. Rectal 5-ASA was superior to rectal cortico steroids for inducing clinical improvement and remission [54].…”

“…The results of a recent meta-analysis indicated that rectal 5-ASA was superior to placebo for inducing symptomatic, endoscopic and histological improvement and remission [54]. Rectal 5-ASA was superior to rectal cortico steroids for inducing clinical improvement and remission [54]. Three randomized controlled trials were conducted to compare the efficacy of intermittent topical 5-ASAs with that of oral 5-ASAs in preventing the relapse of quiescent UC [55][56][57], and two compared rectal combined with oral 5-ASAs [58,59].…”