5-Aminosalicylic acid dependency in Crohn's disease: A Danish Crohn Colitis Database study

Background and aims The role of 5 aminosalicylic acid (5 ASA) in Crohns disease is unclear The outcome of the first course of 5 ASA monotherapy with emphasis on 5 ASA dependency was retrospectively assessed in consecutive cohort of 537 Crohn s disease patients diagnosed 1953-2007 Methods Following outcome definitions were used Immediate outcome (30 days after 5-ASA start) defined as complete/partial response (total regression/improvement of symptoms) and no response (no regression of symptoms with a need of corticosteroids, immunomodulator or surgery) Long term outcome defined as prolonged response (still in complete/partial response 1 year after induction of response), 5 ASA dependency (relapse on stable/reduced dose of 5 ASA requiring dose escalation to regain response or relapse <= 1 year after 5 ASA cessation regaining response after 5 ASA re introduction) Results One hundred sixty five (31%) patients had monotherapy with 5 ASA In 50% 5 ASA monotherapy was initiated <= 1 year after diagnosis (range 0-49 years) Complete/partial response was obtained in 75% and no response in 25% of patients Thirty six percent had prolonged response, 23% developed 5 ASA dependency and 38% were non responders in long term outcome Female gender had higher probability to develop prolonged response or 5 ASA dependency (OR 2 89, 95%Cl 1 08-7 75, p = 0 04) The median duration (range) of 5 ASA monotherapy was 34 months (1-304) in prolonged responders, 63 (6-336) in 5 ASA dependent and 2 (0-10) in non responders Conclusions A selected phenotype of Crohns disease patients may profit from 5 ASA Fifty nine percent of patients obtained long term benefit with 23% becoming 5 ASA dependent Prospective studies are warranted to assess the role of 5 ASA in Crohns disease (C) 2010 European Crohn s and Colitis Organisation Published by Elsevier B V All rights reserved