P384 The usefulness of salazosulfapyridine for patients with ulcerative colitis refractory to mesalazine
T. Yoshino*, S. Yazumi
Kitano Hospital, Division of Gastroenterology and Hepatology, Digestive Disease Centre, Osaka, Japan
Mesalazine is the mainstay of treatment for both induction and maintenance of remission in patients with ulcerative colitis (UC). For UC patients refractory to mesalazine, therapy escalation, such as granulocyte monocyte adsorption apheresis and corticosteroid, would be required. On the other hand, therapy escalation, particularly corticosteroid use, could contribute to induction of UC refractoriness, such as corticosteroid-resistance and -dependence. Salazosulfapyridine (SASP) could deliver a high concentration of 5-aminosalicylic acid to colon, although there were more serious adverse events reported for SASP regrading bloody and hepatic dysfunction than for mesalazine. However, the usefulness of SASP for UC patients refractory to mesalazine remained unclear. The aim of this study is to evaluate the usefulness of SASP for UC patients refractory to mesalazine.
From April 2010 to August 2015, 316 UC patients who had been treated at Kitano hospital were analysed, retrospectively. Clinical and endoscopic activities were evaluated with Lichtiger index and Mayo score, respectively. Mesalazine-refractory UC was defined as sustaining active UC despite treatment with mesalazine. We analysed the induction-remission rate, the propriety of combination-therapy discontinuation and the adverse events related with SASP.
Out of 316 UC patients, 31 (9.8%) with mesalazine-refractory UC were treated with SASP. The median age and disease duration were 41 years (range 18–85 years) and 1.9 years, respectively. The median clinical activity index was 6 points, and the median endoscopic activity index was Mayo-2. Twelve of 31 patients were treated concomitant with topical treatment with mesalazine. Three were intolerant to mesalazine. After initiating treatment with SASP, 20 (64.5%) of 31 UC patients could achieve clinical remission, although the remaining 11 were required therapy escalation. Seven (58.3%) of 12 UC patients treated concomitant with topical treatment with mesalazine before induction of SASP could be discontinued topical treatment. In 3 UC patients intolerant to mesalazine, moreover, SASP could be induced successfully. Adverse events, such as allergy, hepatic dysfunction, and UC exacerbation, were found in 7 patients (22.6%), and were improved after reduction or discontinuation of SASP.
Our data demonstrated that SASP was effective for UC patients refractory to mesalazine resulting in discontinuing combination therapy and avoiding therapy escalation, although adverse events could not be denied.