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The use of 5-aminosalicylate for patients with Crohn's disease in a prospective European inception cohort with 5 years follow-up - an Epi-IBD study.

Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark. Department of Gastroenterology, Örebro University, Örebro, Sweden. Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia. School of Medicine, University of Zagreb, Zagreb, Croatia. Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania. Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain. Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain. Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova. Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation. Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Italy. UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy. Department of Gastroenterology, Azienda USL Toscana Centro, Florence, Italy. IBD Department, Imperial College London, London, UK. IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic. Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic. Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta. Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark. Gastroenterology Department, Odense University Hospital, Odense, Denmark. IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark. Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. Division of Gastroenterology, University Hospital and University of Ioannina, Greece. Hull University Teaching Hospitals NHS Trust, Hull, UK. Hull York Medical School, Hull, UK. Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal. Department of Biomedicine, Porto University, Porto, Portugal. Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands. Division of Gastroenterology, University of Tarty, Tartu, Estonia. Department of Medicine, Herning Central Hospital, Herning, Denmark. Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania. Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania. Gastroenterology Unit, 26993Amiens University Hospital, Amiens, France. Public Health, Epidemiology and Economic Health, Lille University and Hospital, Lille, France. Institute for Translational Research in Inflammation (Infinite), Lille University, Lille, France. Private practice, Nicosia, Cyprus. Department of Gastroenterology and Liver Diseases, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel. Department of Internal Medicine, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel. Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary. 1st Department of Medicine, Semmelweis University, Budapest, Hungary. Division of Gastroenterology, McGill University Health Center, Montreal, Canada. Department of Gastroenterology, 53176Herlev Hospital, University of Copenhagen, Denmark.

United European gastroenterology journal. 2020;(8):949-960
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Abstract

BACKGROUND The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. AIMS The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. METHODS In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. RESULTS Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). CONCLUSION In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

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