Aminosalicylate drugs, particularly mesalazine, may be used for the induction and maintenance of remission in Crohn's disease.
- efficacy of aminosalicylates is small, especially if disease is limited to the ileum
- meta-analysis indicates that aminosalicylates probably only reduce the risk of relapse by about 1/3 in contrast to the 2/3 reduction in relapse rate that is seen with maintenance therapy with aminosalicylates in UC
- patients who relapse on aminosalicylates will need steroid treatment
- the clinical effect of this class of agent is mediated by inhibiting multiple mediators of inflammation, including cytokines, platelet activating factor and possibly leukotriene B4
European evidence-based consensus group and a Cochrane systematic review haven’t found any evidence that aminosalicylates (such as mesalazine) are superior to placebo at maintaining remission in people with medically-induced remission of Crohn’s disease (1).
Mesalazine has been found to reduce relapses after surgery (especially after small bowel resection) (2).
NICE state (3):
- inducing remission in Crohn's disease
- use of 5-ASA for inducing remission in Crohn's disease
- in people who decline, cannot tolerate or in whom glucocorticosteroid treatment is contraindicated, consider 5-aminosalicylate (5-ASA) treatment for a first presentation or a single inflammatory exacerbation in a 12-month period. Explain that aminosalicylates are less effective than a conventional glucocorticosteroid or budesonide but may have fewer side effects than a conventional glucocorticosteroid.
- maintaining remission in Crohn's disease after surgery
- consider 5-ASA treatment to maintain remission after surgery
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