No increased risk of flare in ulcerative colitis patients in corticosteroid-free remission after stopping 5-aminosalicylic acid: A territory-wide population-based study
Joyce W Y Mak
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
State Key Laboratory of Digestive Disease, LKS Institute of Health Science, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
Joyce W Y Mak and Nobel T K Yuen contributed equally to this work.
Search for more papers by this authorNobel T K Yuen
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Joyce W Y Mak and Nobel T K Yuen contributed equally to this work.
Search for more papers by this authorTerry C F Yip
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorRay H M Lam
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorBrian K H Lam
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorCherry T Y Cheng
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorGrace L H Wong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorFrancis K L Chan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
State Key Laboratory of Digestive Disease, LKS Institute of Health Science, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorCorresponding Author
Siew C Ng
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
State Key Laboratory of Digestive Disease, LKS Institute of Health Science, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Correspondence
Siew C Ng, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Email: [email protected]
Search for more papers by this authorJoyce W Y Mak
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
State Key Laboratory of Digestive Disease, LKS Institute of Health Science, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
Joyce W Y Mak and Nobel T K Yuen contributed equally to this work.
Search for more papers by this authorNobel T K Yuen
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Joyce W Y Mak and Nobel T K Yuen contributed equally to this work.
Search for more papers by this authorTerry C F Yip
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorRay H M Lam
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorBrian K H Lam
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorCherry T Y Cheng
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorGrace L H Wong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorFrancis K L Chan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
State Key Laboratory of Digestive Disease, LKS Institute of Health Science, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorCorresponding Author
Siew C Ng
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
State Key Laboratory of Digestive Disease, LKS Institute of Health Science, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Correspondence
Siew C Ng, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Email: [email protected]
Search for more papers by this authorAbstract
Background and Aim
Whether 5-aminosalicylic acid (ASA) can be stopped in patients with stable ulcerative colitis (UC) remains unclear. We aimed to examine whether 5-ASA can be safely withdrawn in UC patients who have been in corticosteroid-free clinical remission for ≥ 1 year.
Methods
This is a retrospective cohort study using territory-wide healthcare database in Hong Kong. Primary outcome was development of UC flare, defined as new corticosteroid use or UC-related hospitalizations within 5 years. UC patients on oral 5-ASA ≥ 2 g daily for ≥ 1 year with C-reactive protein (CRP) < 10 mg/dL and no 5-ASA dosage escalation, UC-related hospitalization or corticosteroid use in the past year were included. Patients on biological agents were excluded. Patients were classified as “stopping” if 5-ASA was withdrawn for ≥ 90 days within follow-up period. We performed multivariable Cox regression models adjusting for demographics, blood parameters and immunosuppressants used. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was reported comparing stopping and continuous-use groups.
Results
A total of 1408 patients were included with a median follow-up duration of 41.8 months (interquartile range [IQR]: 17.2–60.0 months). Stopping 5-ASA was not associated with an increased risk of UC flare (aHR 0.91; 95% CI 0.64–1.31; P = 0.620). A higher CRP levels at the time of stopping 5-ASA (aHR 1.15; 95% CI: 1.01–1.30; P = 0.037) were associated with increased risk of flare.
Conclusion
Stopping 5-ASA in UC patients in corticosteroid-free remission for ≥ 1 year was not associated with increased risk of flare. Future prospective trials should evaluate the role of stopping 5-ASA in stable UC patients.
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