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P437. Maintaining remission in ulcerative colitis: 5-aminosalicylic acid (5-ASA) therapy

S. Din1, J. O'Kelly1, I. Arnott1, 1NHS Lothian, GI Unit, Edinburgh, United Kingdom

Background

5-Aminosalicylic Acids (5-ASAs) play a key role in both the induction and maintenance of remission in Ulcerative Colitis (UC). A number of questions remain poorly assessed by clinical trials including the dose, dose interval, preparation and delivery method that is most effective in maintaining remission in this group of patients.

Methods

An inception cohort of 100 (45 males) newly diagnosed UC patients were retrospectively assessed and followed up for 3 years. Data were collected on 5-ASA maintenance therapy along with information relating to disease activity. Length of remission was estimated using median time to relapse and groups were compared using Mantel–Cox (log rank) test and Hazard Ratios.

Results

77 received an oral 5-ASA, 11 topical therapy and 12 had combined treatment. 76% of patients relapsed by 3 years follow up; with a mean time to relapse of 11 months (range 1–32). No significant difference was found in the length of first remission or risk of relapse between Asacol and Pentasa preparations, once, twice and three times dosing schedule, high dose (4.8g/day) or low dose (2.4g/day) and oral or combined delivery methods. Moderate disease at presentation had a significantly shorter length of remission (p = 0.006) and a 2-fold increase in risk of relapse compared with mild disease at presentation. All patients who presented with severe disease relapsed with a median time to relapse of 8 months. Disease extent at time of diagnosis, agents used to induce remission and time to remission did not predict risk of relapse.

Conclusion

The results would suggest that differences in 5-ASA preparation or dosing schedules do not influence the maintenance of remission in UC. Low dose and uni-directional approaches to therapy may have a more favourable outcome indicating that concordance with therapy remains a vital aspect of 5-ASA efficacy.

Disease severity and not disease extent may have an independent role in determining the risk of relapse.