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).
. 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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"Aminosalicylates for Induction of Remission or Response in Crohn's Disease." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/457224/all/Aminosalicylates_for_induction_of_remission_or_response_in_Crohn's_disease.
Aminosalicylates for induction of remission or response in Crohn's disease. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/457224/all/Aminosalicylates_for_induction_of_remission_or_response_in_Crohn's_disease. Accessed March 31, 2023.
Aminosalicylates for induction of remission or response in Crohn's disease. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. https://evidence.unboundmedicine.com/evidence/view/EBMG/457224/all/Aminosalicylates_for_induction_of_remission_or_response_in_Crohn's_disease
Aminosalicylates for Induction of Remission or Response in Crohn's Disease [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2023 March 31]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/457224/all/Aminosalicylates_for_induction_of_remission_or_response_in_Crohn's_disease.
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T1 - Aminosalicylates for induction of remission or response in Crohn's disease
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PB - Duodecim Medical Publications Limited
DB - Evidence Central
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