Guidelines for the treatment of ulcerative colitis in remission

European Journal of Gastroenterology and Hepatology

Volumn 9, Issue 9, 1997, Pages 836-841

  Ardizzone, Sandro ^a   Molteni, Paola ^a   Bollani, Simona ^a   Porro, Gabriele Blanchi ^a  

^a UNIVERSITY OF MILAN   (Italy)

Author keywords

5 ASA; Corticosteroids; Immunosuppressants; Sulphasalazine; Ulcerative colitis in remission

Indexed keywords

AZATHIOPRINE; CORTICOSTEROID; IMMUNOSUPPRESSIVE AGENT; MERCAPTOPURINE; MESALAZINE; SALAZOSULFAPYRIDINE;

HUMAN; MAINTENANCE THERAPY; ORAL DRUG ADMINISTRATION; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROCTITIS; RECTAL DRUG ADMINISTRATION; RELAPSE; REMISSION; REVIEW; ULCERATIVE COLITIS;

EID: 0030809613     PISSN: 0954691X     EISSN: None     Source Type: Journal    
DOI: 10.1097/00042737-199709000-00003     Document Type: Review

References (27)

1. Misiewicz JJ, Lennard-Jones JE, Connell AM, et al.: Controlled trial of sulphasalazine in maintenance therapy for ulcerative colitis. Lancet 1965, i:185-188. This is the first trial showing the effectiveness of SSZ in dramatically reducing the number of relapses in patients with UC in remission. Since then, sulphasalazine has become the standard drug to compare to any other pharmacological agents in treating UC patients in remission.
2. Kornbluth AA, Salomon, Sacks HS, et al.: Meta-analysis of the effectiveness of current drug therapy of ulcerative colitis. J Clin Gastroenterol 1993, 16:215-218. A meta-analysis of 16 placebo-controlled trials of single drug therapy in UC for both induction and maintenance of remission, establishing a standard of reference against which future drug trials can be compared.
3. Das KM: Sulfasalazine therapy in inflammatory bowel disease. Gastroenterol Clin North Am 1989, 18:1-20. The role of SSZ in the treatment of the inflammatory bowel is reviewed, giving particular emphasis to the safety and tolerability of this drug.
4. Sutherland LR, May GR, Shaffer EA: Sulfasalazine revisited: a meta-analysis of 5-aminosalicylic acid in the treatment of ulcerative colitis. Ann Intern Med 1993, 118:540-549. A meta-analytic review of the effectiveness of the newer delivery systems compared to placebo or SSZ for the treatment of active UC and for the maintenance of remission. Although they offer benefit to SSZ-sensitive patients, the use of 5-ASA formulations instead of SSZ in the treatment of UC cannot yet be substantiated.
5. Marshall JK, Irvine EJ: Rectal aminosalicylate therapy for distal ulcerative colitis: a meta-analysis. Aliment Pharmacol Ther 1995, 9:293-300. A meta-analysis that summarizes and quantifies the evidence supporting rectal 5- or 4-ASA therapies for disease exacerbation or remission maintenance in distal UC.
6. Sandborn WF: A review of immune modifier therapy for inflammatory bowel disease: azathioprine, 6-mercaptopurine, cyclosporine and methotrexate. Am J Gastroenterol 1996, 91:423-433. The role of available immunosuppressant agents in the treatment of inflammatory bowel disease is critically reviewed, particularly in terms of mechanism of action, therapeutic application and safety.
7. Adler DJ, Korelitz BI: The therapeutic efficacy of 6-mercaptopurine in refractory ulcerative colitis. Am J Gastroenterol 1990, 85:717-722.
8. Ardizzone S, Molteni P, Imbesi V, et al.: Azathioprine in steroid-resistant and steroid-dependent ulcerative colitis. J Clin Gastroenterol 1997 (in press). Two of the several open studies showing the efficacy of AZA or 6-MP in reducing clinical relapses and steroid requirements in patients with steroid-dependent or steroid-resistant UC.
9. Hawthorne AB, Logan RFA, Hawkey CJ, et al.: Randomised controlled trial of azathioprine withdrawal in ulcerative colitis. BMJ 1992, 305:20-22. The first trial showing that maintenance treatment in ulcerative colitis is beneficial for at least 2 years if patients have achieved remission during therapy with the drug, and that azathioprine withdrawal is associated with more relapses than continuing the drug.
10. George J, Present DH, Pou R, et al.: The long-term outcome of ulcerative colitis treated with 6-MP. Am J Gastroenterol 1996, 91:1711-1714. A retrospective evaluation of the long-term outcome of a large series of patients with refractory ulcerative colitis treated with 6-MP, showing that the drug is a reasonably safe and effective treatment for these patients.
11. Lichtiger S, Present DH, Kornbluth A, et al.: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994, 330:1841-1845. An important placebo-controlled study showing the efficacy of intravenous cyclosporin A in the treatment of patients with acute, severe ulcerative colitis. Their results are changing the gastroenterologist's therapeutic approach to this group of patients.
12. Marion JF, Present DH: 6-MP maintains cyclosporine induced response in patients with ulcerative colitis [abstract]. Am J Gastroenterol 1996, 91:1975.
13. Fernandez-Beñares F, Bertran X, Esteve-Comas M, et al.: Azathioprine is useful in maintaining long-term remission induced by intravenous cyclosporine in steroid-refractory severe ulcerative colitis. Am J Gastroenterol 1996, 91:2498-2499. Two small series of patients with cyclosporin-induced remission, in whom long-term treatment with 6-MP and azathioprine are effective in maintaining remission.
14. Truelove SC, Witts LJ: Cortisone and corticotropin in acute ulcerative colitis. BMJ 1959, 2:287-394. One of the first studies showing the efficacy of steroid administration in the treatment of ulcerative colitis, greatly influencing the worldwide therapy of acute ulcerative colitis.
15. Lennard-Jones JE, Misiewicz JJ, Connell AM, et al.: Prednisone as maintenance treatment for ulcerative colitis in remission. Lancet 1965, i:188-189.
16. Powell-Tuck J, Bown RL, Chambers TJ, et al.: A controlled trial of alternate day prednisolone as a maintenance treatment for ulcerative colitis in remission. Digestion 1981, 22:263-270. Two important well conducted controlled trials showing that corticosteroids are ineffective in the maintenance treatment of ulcerative colitis in remission.
17. D'Arienzo A, Panarese A, D'Armiento FP, et al.: 5-Aminosalicylic acid suppositories in the maintenance of remission in idiopathic proctitis or proctosigmoiditis: a double-blind placebo-controlled clinical trial. Am J Gastroenterol 1990, 85:1079-1082.
18. D'Albasio G, Paoluzi P, Bianchi Porro G, et al.: Ulcerative proctitis remission maintenance with 5-ASA suppositories. A double-blind placebo controlled trial [abstract]. Ital J Gastroenterol 1995, 27(suppl. 1):79. Two Italian studies in which patients with ulcerative proctitis in remission were treated with 5-ASA suppositories as a maintenance treatment, showing the efficacy of 5-ASA topical therapy in prolonging disease remission.
19. D'Albasio G, Pacini F, Camarri E, et al.: Combined therapy with 5-aminosalicylic acid tablets and enemas for maintaining remission in ulcerative colitis. Results at 12 months [abstract]. Ital J Gastroenterol 1995, 27(suppl. 1):79. An interesting trial showing the efficacy of combined therapy with 5-ASA tablets and 5-ASA enemas against 5-ASA tablets and placebo enemas, in maintaining remission in ulcerative colitis patients having a history of relapse frequency of at least two in the least year.
20. Azad Khan AK, Howes DT, Piris J, et al.: Optimum dose of sulphasalazine for maintenance treatment in ulcerative colitis. Gut 1980, 21:232-240. A dose-ranging study demonstrating that sulphasalazine at a dosage of 2 g daily is significantly more effective than 1 g daily and better tolerated than 4 g daily, in the maintenance treatment of ulcerative colitis in remission.
21. Travis SPL, Tysk C, de Silva HJ, et al.: Optimum dose of olsalazine for maintaining remission in ulcerative colitis. Gut 1994, 35:1282-1286.
22. Fockens P, Mulder JJ, Tytgat GNJ, et al.: Comparison of the efficacy and safety of 1.5 compared with 3.0 g oral slow-release mesalazine (Pentasa) in the maintenance treatment of ulcerative colitis. Eur J Gastroenterol Hepatol 1995, 7:1025-1030.
23. The Mesalamine Study Group: An oral preparation of mesalamine as long-term maintenance therapy for ulcerative colitis. A randomized, placebo-controlled trial. Ann Intern Med 1996, 124:204-211. Three large controlled trials from Europe and the USA, comparing different doses of 5-ASA in the treatment of ulcerative colitis in remission. A trend towards a higher remission rate was noted with higher doses of 5-ASA, especially in patients with a minor duration of remission before entering the study.
24. Riis P, Anthonisen P, Wulff HR, et al.: The prophylactic effect of salazosulphapyridine in ulcerative colitis during long-term treatment. A double-blind trial on patients asymptomatic for one year. Scand J Gastroenterol 1973, 8:71-74.
25. Dissanayake AS, Truelove SC: A controlled trial of long-term maintenance treatment of ulcerative colitis with sulphasalazine (Salazopyrin). Gut 1973, 14:923-926. Two important studies reporting conflicting results concerning the question of whether or not patients with ulcerative colitis should be treated indefinitely. In particular, while the former suggest that patients asymptomatic for at least 1 year may discontinue the active treatment, the latter concludes that patients who stopped therapy are at high risk of relapse.
26. Ardizzone S, Petrillo M, Imbesi V, et al.: Is maintenance therapy always necessary for patients with ulcerative colitis in remission? A 5-ASA double-blind, double-dummy, placebo-controlled trial. (In press). The results of this study show that 5-ASA prophylaxis is necessary for preventing ulcerative colitis relapses in patients in remission for less than 2 years, and cast doubts as to whether or not continuous maintenance is still necessary in patients with prolonged clinical, endoscopic and histological remission.
27. Azad Khan AK, Piris J, Truelove SC. An experiment to determine the active therapeutic moiety of suphasalazine. Lancet 1977, ii:892-895. Historical study showing that the active moiety of SSZ is 5-ASA.