Year 2021 / Volume 113 / Number 6
Review
Risk factors and management strategies associated with non-response to aminosalicylates as a maintenance treatment in ulcerative colitis

447-453

DOI: 10.17235/reed.2021.7797/2021

David Martí-Aguado, María Pilar Ballester, Miguel Mínguez,

Abstract
Aminosalicylates (5-ASA) are used as the first-line maintenance treatment in patients with mild-moderate ulcerative colitis (UC). Early identification of patients at high risk for 5-ASA non-response and appropriate therapeutic escalation are essential to avoid disease progression. However, the absence of a standardized definition for treatment success makes this a challenging task. The focus of the current review was to describe the risk factors and management strategies associated with 5-ASA non-response. Rates of 5-ASA failure can vary from 17 % to 75 % according to different success definitions, of which clinical relapse is the most prevalent and studied condition. Younger age and endoscopic activity at diagnosis, extensive colitis, early need for corticosteroids, elevated inflammatory markers and non-adherence are consistent risk factors of 5-ASA failure. Given the effectiveness, safety profile and tolerability of this medication, therapy optimization is critical before treatment escalation. Combined use of systemic and topical therapy at an appropriate dose in a once-daily administration and control of adherence could improve success rates.
Share Button
New comment
Comments
No comments for this article
References
1. Fumery M, Singh S, Dulai PS, et al. Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review. Clin Gastroenterol Hepatol. 2018;16(3): 343-356.e3.
2. Marti-Aguado D, Ballester MP, Tosca J, et al. Long-term follow-up of patients treated with aminosalicylates for ulcerative colitis: Predictive factors of response: An observational case-control study. United European Gastroenterol J. 2019 Oct;7(8):1042-1050.
3. Bressler B, Marshall JK, Bernstein CN, et al. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: The Toronto consensus. Gastroenterology. 2015; 148(5): 1035-1058.e3.
4. Schoepfer AM, Vavricka S, Zahnd-Straumann N, et al. Monitoring inflammatory bowel disease activity: clinical activity is judged to be more relevant than endoscopic severity or biomarkers. J Crohns Colitis. 2012; 6(4): 412-418.
5. Fukuda T, Naganuma M, Takabayashi K, et al. Mucosal concentrations of N-acetyl-5-aminosalicylic acid related to endoscopic activity in ulcerative colitis patients with mesalamine. J Gastroenterol Hepatol. Epub ahead of print 2020 Apr 6. DOI:10.1111/jgh.15059.
6. Ballester MP, Marti-Aguado D, Fullana M, et al. Impact and risk factors of non-adherence to 5-aminosalicylates in quiescent ulcerative colitis evaluated by an electronic management system. Int J Colorectal Dis. 2019; 34(6): 1053-1059.
7. Fukuda T, Naganuma M, Sugimoto S, et al. The risk factor of clinical relapse in ulcerative colitis patients with low dose 5-aminosalicylic acid as maintenance therapy: A report from the IBD registry. PLoS ONE. 2017; 12(11): e0187737.
8. Nagahori, M., Kochi, S., Hanai, H. et al. Real life results in using 5-ASA for maintaining mild to moderate UC patients in Japan, a multi-center study, OPTIMUM Study. BMC Gastroenterol. 2017; 17: 47.
9. Garcia-Planella E, Mañosa M, Chaparro M, et al. Serial semi-quantitative measurement of fecal calprotectin in patients with ulcerative colitis in remission. Scand J Gastroenterol. 2018; 53(2): 152-157.
10. Prosberg MV, Vester-Andersen MK, Andersson M, et al. Long-term Compliance with Oral 5-aminosalicylic Acid Therapy and Risk of Disease Recurrence in Patients with Ulcerative Colitis: A Population-based Cohort Study. Inflamm Bowel Dis. 2016; 22(4): 925-932.
11. Richter JM, Arshi NK, Oster G. Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications. Can J Gastroenterol Hepatol. 2016; 2016: 6928710.
12. Yamamoto T, Shimoyama T, Matsumoto K. Consecutive monitoring of faecal calprotectin during mesalazine suppository therapy for active rectal inflammation in ulcerative colitis. Aliment Pharmacol Ther. 2015; 42: 549–558.
13. Yokoyama K, Kobayashi K, Mukae M, et al. Clinical study of the relation between mucosal healing and long-term outcomes in ulcerative colitis. Gastroenterol Res Prac. 2013; 2013: 192794.
14. Lee HJ, Jung ES, Lee JH, et al. Long-term clinical outcomes and factors predictive of relapse after 5-aminosalicylate or sulfasalazine therapy in patients with mild-to-moderate ulcerative colitis. Hepatogastroenterology. 2012; 59: 1415–1420.
15. Garcia-Planella E, Mañosa M, Van Domselaar M, et al. Long-term outcome of ulcerative colitis in patients who achieve clinical remission with a first course of corticosteroids. Dig Liver Dis. 2012; 44: 206–210.
16. Bello C, Belaiche J, Louis E, et al. Evolution and predictive factors of relapse in ulcerative colitis patients treated with mesalazine after a first course of corticosteroids. J Crohns Colitis. 2011; 5: 196–202.
17. Höie O, Wolters F, Riis L, et al. Ulcerative colitis: Patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort. Am J Gastroenterol. 2007; 102: 1692–1701.
18. Bitton A, Peppercorn MA, Antonioli DA, et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology. 2001; 120: 13–20.
19. Navarro F, Hanauer SB. Treatment of Inflammatory Bowel Disease: Safety and Tolerability Issues. Am J Gastroenterol. 2003; 98:S18–S23.
20. Velayos FS, Terdiman JP, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and meta-analysis of observational studies. Am J Gastroenterol. 2005; 100:1345–1353
21. Yokoyama H, Takagi S, Kuriyama S, et al. Effect of weekend 5-aminosalicylic acid (mesalazine) enema as maintenance therapy for ulcerative colitis: Results from a randomized controlled study. Inflamm Bowel Dis. 2007;13:1115–1120.
22. Pica R, Cassieri C, Cocco A, et al. A randomized trial comparing 4.8 vs. 2.4g/day of oral mesalazine for maintenance of remission in ulcerative colitis. Digest Liver Dis. 2015; 47:933–937.
23. Suzuki Y, Iida M, Ito H, et al. 2.4 g Mesalamine (Asacol 400 mg tablet) Once Daily is as Effective as Three Times Daily in Maintenance of Remission in Ulcerative Colitis: A Randomized, Noninferiority, Multi-center Trial. Inflamm Bowel Dis. 2017; 23:822–832.
24. Kane SV, Robinson A. Review article: understanding adherence to medication in ulcerative colitis –innovative thinking and evolving concepts. Aliment Pharmacol Ther. 2010; 32(9):1051–1058.
25. Peyrin-Biroulet L, Ferrante M, Magro F, et al. Results from the 2nd Scientific Workshop of the ECCO. I: impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis. 2011; 5:477–483.
Related articles

Letter

Tofacitinib-induced eosinophilia

DOI: 10.17235/reed.2023.9831/2023

Letter

Lymphocytic colitis with macroscopic findings

DOI: 10.17235/reed.2023.9497/2023

Letter

Hepatosplenic T-cell lymphoma and inflammatory bowel disease

DOI: 10.17235/reed.2023.9472/2023

Letter

Perianal Paget’s disease

DOI: 10.17235/reed.2022.9304/2022

Digestive Diseases Image

Black esophagus

DOI: 10.17235/reed.2022.9217/2022

Letter

Chinese dragon sign of ulcerative colitis

DOI: 10.17235/reed.2022.9154/2022

Letter

Ulcerative colitis exacerbated by strongyloidiasis

DOI: 10.17235/reed.2022.9044/2022

Letter

Upadacitinib in refractory ulcerative colitis

DOI: 10.17235/reed.2022.8870/2022

Letter

Intestinal disease secondary to tocilizumab

DOI: 10.17235/reed.2022.8818/2022

Review

Clinical settings with tofacitinib in ulcerative colitis

DOI: 10.17235/reed.2022.8660/2022

Letter

NSAID-induced ischemic colitis

DOI: 10.17235/reed.2022.8605/2022

Letter

Mesalazine induced interstitial pneumonitis in the COVID era

DOI: 10.17235/reed.2022.8635/2021

Digestive Diseases Image

Portal pneumatosis in a patient with severe Salmonella colitis

DOI: 10.17235/reed.2021.8090/2021

Digestive Diseases Image

Phlebosclerotic colitis: an unusual cause of abdominal pain and hematochezia

DOI: 10.17235/reed.2020.7358/2020

Letter

The effect of Adacolumn® on ulcerative colitis with COVID-19

DOI: 10.17235/reed.2020.7156/2020

Rapid reviews

COVID-19, coronavirus, SARS-CoV-2 and the small bowel

DOI: 10.17235/reed.2020.7137/2020

Letter

Sweet syndrome in severe ulcerative flare

DOI: 10.17235/reed.2020.6995/2020

Editorial

Lung transplantation and esophageal dysfunction

DOI: 10.17235/reed.2018.5693/2018

Digestive Diseases Image

Immune mediated colitis caused by lung cancer treatment with atezolizumab

DOI: 10.17235/reed.2017.5060/2017

Original

Colonic diverticulosis and the metabolic syndrome: an association?

DOI: 10.17235/reed.2017.5009/2017

Letter to the Editor

Cytomegalovirus: associated ischemic colitis in an immunocompetent patient

DOI: 10.17235/reed.2017.4937/2017

Letter to the Editor

Ulcerative colitis with gastric and duodenal involvement

DOI: 10.17235/reed.2017.4685/2016

Editorial

Specialist care in the management of inflammatory bowel disease

DOI: 10.17235/reed.2016.4628/2016

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Letter to the Editor

Ischemic colitis in an athlete: running is not always good for you

DOI: 10.17235/reed.2016.4184/2015

Case Report

Mesalamine-induced myopericarditis - A case report

DOI: 10.17235/reed.2016.4016/2015

Digestive Diseases Image

Fatal Campylobacter jejuni ileocolitis

Case Report

Severe ischemic colitis following olanzapine use - A case report

DOI: 10.17235/reed.2016.3944/2015

Case Report

Olanzapine-induced ischemic colitis

DOI: 10.17235/reed.2015.3856/2015

Citation tools
Martí-Aguado D, Ballester M, Mínguez M. Risk factors and management strategies associated with non-response to aminosalicylates as a maintenance treatment in ulcerative colitis. 7797/2021


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1555 visits.
This article has been downloaded 269 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 15/01/2021

Accepted: 21/01/2021

Online First: 11/02/2021

Published: 04/06/2021

Article revision time: 2 days

Article Online First time: 27 days

Article editing time: 140 days


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology