Aminosalicylates for induction of remission or response in Crohn's disease

Evidence Summaries

Level of Evidence = C
Aminosalicylates may be more effective than placebo but less effective than corticosteroids in inducing remission in Crohn’s colitis.

A Cochrane review 1 included 20 studies with a total of 2367 subjects comparing aminosalicylates to placebo or corticosteroids for induction of remission or clinical response in Crohn´s disease.

Sulfasalazine was more likely to induce remission (RR 1.38; 95% CI 1.02 to 1.87; n = 263) compared to placebo with benefit confined mainly to patients with colitis, but was less effective than corticosteroids (RR 0.66; 95% CI 0.53 to 0.81; n = 260).

The benefit of low dose (RR = 1.46, 95% CI 0.89 to 2.40; n = 302) or high dose (3 to 4.5 g/day) mesalamine (RR 2.02; 95% CI 0.75 to 5.45) was not statistically significant compared to placebo for induction of remission. No statistically significant difference was found between high dose mesalamine and conventional corticosteroids (RR 1.04; 95% CI 0.79 to 1.36; n = 178). In a single randomized controlled trial, 5-ASA was inferior to budesonide (RR 0.56; 95% CI 0.40 to 0.78, n = 182). There was a lack of good quality clinical trials comparing sulfasalazine with other mesalamine formulations.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (limited study size for each comparison).

References

1. Lim WC, Wang Y, MacDonald JK et al. Aminosalicylates for induction of remission or response in Crohn's disease. Cochrane Database Syst Rev 2016;(7):CD008870.  [PMID:27372735]

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