RT Journal Article
SR Electronic
T1 Usefulness of sulfasalazine for patients with refractory-ulcerative colits
JF BMJ Open Gastroenterology
FD BMJ Publishing Group Ltd
SP e000103
DO 10.1136/bmjgast-2016-000103
VO 3
IS 1
A1 Takuya Yoshino
A1 Makoto Sono
A1 Shujiro Yazumi
YR 2016
UL http://bmjopengastro.bmj.com//content/3/1/e000103.abstract
AB Background Patients with refractory-ulcerative colitis (UC) require therapy escalation. Sulfasalazine (SASP) could deliver a high concentration of 5-aminosalicylic acid to the colon. The usefulness of SASP for refractory-UC patients, however, is unclear.Aim The aim was to evaluate the usefulness of SASP for refractory-UC patients.Method We retrospectively analysed 36 (11.4%) of 316 patients with refractory-UC who had been treated with SASP. Clinical and endoscopic activities were evaluated with Lichtiger index and Mayo score, respectively. We analysed the induction-remission rate, predictive factors for the efficacy of SASP, and adverse events.Results Of 36 refractory-UC patients, 14 (38.9%) were treated with concomitant mesalazine enemas, 10 (27.8%) with azathiopurine, 4 (11.1%) with tacrolimus and 6 (16.7%) with an antitumour necrosis factor-α agent. After initiating SASP treatment, 25 patients (69.4%) achieved clinical remission. In 9 (64.3%) of 14 patients with UC treated with mesalazine enemas, mesalazine enemas could be discontinued with SASP. In all patients treated with tacrolimus, tacrolimus could be discontinued with SASP. Clinical activity score upon the initiation of SASP was significantly lower (p=0.024) and the number of patients treated with thiopurine was significantly higher (p=0.016) in the clinical remission group than in the non-clinical remission group. These factors might be predictive for the efficacy of SASP, although multivariate analysis demonstrated no statistically significant effect. Adverse events occurred in 7 patients (19.4%), and reduction or discontinuation of SASP led to improvement.Conclusions SASP appears to be more effective for refractory-UC patients with low clinical-activity and/or thiopurine-use.Trial registration number UMIN000021615; Results.