High mucosal healing rates in 5‐ASA‐treated ulcerative colitis patients: Results of a meta‐analysis of clinical trials

• Published in: Inflammatory bowel diseases Vol. 18; no. 11; pp. 2190 - 2198
• Main Authors: Römkens, Tessa E.H., Kampschreur, Milou T., Drenth, Joost P.H., van Oijen, Martijn G.H., de Jong, Dirk J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-11-2012; Oxford University Press
• Subjects: 5‐ASA; Clinical trials; Clinical Trials as Topic; Colitis, Ulcerative - drug therapy; Drug therapy; Humans; Inflammatory bowel disease; Intestinal Mucosa - drug effects; Intestinal Mucosa - pathology; Mesalamine - therapeutic use; mucosal healing; systematic review; ulcerative colitis; Wound Healing - drug effects
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.22939

Background:
Recently, mucosal healing (MH) is regarded as an important treatment goal in ulcerative colitis (UC). 5‐Aminosalicylates (5‐ASA) are the standard treatment in mild‐to‐moderate UC, but the effect on MH is less known. The aim of this study was to systematically review the medical literature in order to compare different preparations of 5‐ASA for the effect on MH.
Methods:
We conducted a structured search of PubMed and the Cochrane Central Register of Controlled Trials to identify randomized controlled clinical trials with 5‐ASA in UC providing data about MH. We calculated the sample size‐weighted pooled proportion of patients with MH, and performed meta‐analysis of head‐to‐head comparisons.
Results:
Out of 645 hits, we included 90 treatment arms, involving 3977 patients using oral 5‐ASA (granulate and tablets) and 2513 patients using rectal 5‐ASA (suppositories, enema, and foam). Overall, 43,7% of 5‐ASA treated patients achieved MH (oral 36,9%; rectal 50,3%). In oral studies, 49% of patients using granulate (7 treatment‐arms) achieved MH compared to 34,9% using tablets (43 treatment‐arms). In rectal studies the proportion of MH was 62% for suppositories (eight treatment arms), 51% for foam (nine treatment arms), and 46% for enema (23 treatment arms), respectively.
Conclusions:
5‐ASA preparations achieved MH in nearly 50% of UC patients. There were no significant differences in MH between the various 5‐ASA agents, either in the oral or the rectal treatment groups. (Inflamm Bowel Dis 2012;)