Evidence Summaries

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