Abstract
BackgroundUlcerative colitis (UC) is a chronic and remitting inflammatory disease that is characterized by chronic idiopathic inflammation of the colon and bloody diarrhea. Currently drug treatment is the main intervention for patients with mild to moderate UC. Mesalazine (5-ASA) and beclomethasone dipropionate (BDP) have been widely used for the treatment of UC and have yielded satisfactory results. This study compared the effectiveness of 5-ASA and BDP in the treatment of UC.MethodsThe PubMed, Medline, SinoMed, Embase, and Cochrane Librinary databases were searched for eligible studies. Data were extracted by two of the coauthors independently and were analyzed using RevMan statistical software, version 5.3. Weighted mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration’s Risk of Bias Tool was used to assess the risk of bias.ResultsSeven randomized controlled trials that compared BDP with 5-ASA in treating UC were identified as eligible. The methodological quality of the trials ranged from low to moderate. A pooled analysis of effectiveness based on the Disease Activity Index (DAI) or other assessment method after treatment revealed that in the treatment of UC, there are no obvious differences between BDP and 5-ASA in inducing remission and clinical improvement (OR = 0.76, 95% CI = 0.56–1.03, P = 0.08). The total numbers of adverse events associated with BDP and 5-ASA treatments for UC were similar (OR = 1.21, 95% CI = 0.71–2.09, P = 0.48). The safety profiles for these two drugs are good. According to subgroup-analysis, we found no obvious differences of clinical efficacy between BDP and 5-ASA no matter oral or enema administration was used in the treatment of UC. A sensitivity analysis demonstrated the stability of the pooled results.ConclusionDuring induction treatment of mild to moderate UC, there is no obvious difference between the two groups with respect to remission and clinical improvement. Given that the upper confidence limit for the OR barely exceeds 1.0 and that the p-value is close to 0.05 for this primary efficacy outcome as well as that the horizontal block lies to the left of the vertical line, it indicates that the clinical efficacy of BDP may be better than 5-ASA. However, taking into account that BDP has the risk of hypothalamic-pituitary-adrenal axis (HPA) suppression, 5-ASA has a potential advantage of safety in the treatment of mild to moderate UC.
Highlights
Ulcerative colitis (UC) is an idiopathic condition characterized by intermittent episodes of chronic inflammatory bowel disease that has become a worldwide disease [1]
A pooled analysis of effectiveness based on the Disease Activity Index (DAI) or other assessment method after treatment revealed that in the treatment of UC, there are no obvious differences between beclomethasone dipropionate (BDP) and 5-aminosalicylic acid (5-ASA) in inducing remission and clinical improvement (OR = 0.76, 95% confidence intervals (CIs) = 0.56–1.03, P = 0.08)
The total numbers of adverse events associated with BDP and 5-ASA treatments for UC were similar (OR = 1.21, 95% CI = 0.71–2.09, P = 0.48)
Summary
Ulcerative colitis (UC) is an idiopathic condition characterized by intermittent episodes of chronic inflammatory bowel disease that has become a worldwide disease [1]. Patients often experience intermittent episodes of disease activity that can seriously affect their health and quality of life [5]. The only major indications for surgical treatment are life-threatening acute severe UC, ineffectiveness of drug treatment, and recurrence and serious impact on daily living in patients with chronic UC. It was noted in the 2010 American Gastroenterology Practice Guidelines that topical or oral 5-aminosalicylic acid (5-ASA) and corticosteroids can be recommended as treatments for mild-to-moderate UC [6]. This study compared the effectiveness of 5-ASA and BDP in the treatment of UC.
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