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Yoshino T, Sono M, Yazumi S. Usefulness of sulfasalazine for patients with refractory-ulcerative colits. BMJ Open Gastroenterol. 2016;3(1):e000103doi: 10.1136/bmjgast-2016-000103.
Yoshino, T., Sono, M., & Yazumi, S. (2016). Usefulness of sulfasalazine for patients with refractory-ulcerative colits. BMJ open gastroenterology, 3(1), e000103. https://doi.org/10.1136/bmjgast-2016-000103
Yoshino, Takuya, et al. "Usefulness of sulfasalazine for patients with refractory-ulcerative colits." BMJ open gastroenterology vol. 3,1 (2016): e000103. doi: https://doi.org/10.1136/bmjgast-2016-000103
Yoshino T, Sono M, Yazumi S. Usefulness of sulfasalazine for patients with refractory-ulcerative colits. BMJ Open Gastroenterol. 2016 Aug 16;3(1):e000103. doi: 10.1136/bmjgast-2016-000103. eCollection 2016. PMID: 27648296; PMCID: PMC5013332.
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BMJ Open Gastroenterol. 2016 Aug 16;3(1):e000103. doi: 10.1136/bmjgast-2016-000103. eCollection 2016.

Usefulness of sulfasalazine for patients with refractory-ulcerative colits.

BMJ open gastroenterology

Takuya Yoshino, Makoto Sono, Shujiro Yazumi

Affiliations

  1. Division of Gastroenterology and Hepatology , Digestive Disease Center, Kitano Hospital , Osaka , Japan.

PMID: 27648296 PMCID: PMC5013332 DOI: 10.1136/bmjgast-2016-000103

Abstract

BACKGROUND: Patients with refractory-ulcerative colitis (UC) require therapy escalation. Sulfasalazine (SASP) could deliver a high concentration of 5-aminosalicylic acid to the colon. The usefulness of SASP for refractory-UC patients, however, is unclear.

AIM: The aim was to evaluate the usefulness of SASP for refractory-UC patients.

METHOD: We retrospectively analysed 36 (11.4%) of 316 patients with refractory-UC who had been treated with SASP. Clinical and endoscopic activities were evaluated with Lichtiger index and Mayo score, respectively. We analysed the induction-remission rate, predictive factors for the efficacy of SASP, and adverse events.

RESULTS: Of 36 refractory-UC patients, 14 (38.9%) were treated with concomitant mesalazine enemas, 10 (27.8%) with azathiopurine, 4 (11.1%) with tacrolimus and 6 (16.7%) with an antitumour necrosis factor-α agent. After initiating SASP treatment, 25 patients (69.4%) achieved clinical remission. In 9 (64.3%) of 14 patients with UC treated with mesalazine enemas, mesalazine enemas could be discontinued with SASP. In all patients treated with tacrolimus, tacrolimus could be discontinued with SASP. Clinical activity score upon the initiation of SASP was significantly lower (p=0.024) and the number of patients treated with thiopurine was significantly higher (p=0.016) in the clinical remission group than in the non-clinical remission group. These factors might be predictive for the efficacy of SASP, although multivariate analysis demonstrated no statistically significant effect. Adverse events occurred in 7 patients (19.4%), and reduction or discontinuation of SASP led to improvement.

CONCLUSIONS: SASP appears to be more effective for refractory-UC patients with low clinical-activity and/or thiopurine-use.

TRIAL REGISTRATION NUMBER: UMIN000021615; Results.

Keywords: 5-AMINOSALICYLIC ACID (5-ASA); 6-MERCAPTOPURINE; AZATHIOPRINE; ULCERATIVE COLITIS

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