Oral 5-aminosalicylates for prevention of postoperative relapses in crohn's disease

Abstract

<h3>Background</h3> The use of 5-aminosalicylates (5-ASAs) in Crohn9s disease (CD) is controversial. A recent Cochrane review found that 5-ASAs are not effective for the maintenance of medically-induced remission in CD but their role in the maintenance of surgically-induced remission is unclear. <h3>Aim</h3> To evaluate articles that investigated the use of 5-ASAs for prevention of postoperative relapses in CD. <h3>Design</h3> Systematic review and meta-analyses of randomised controlled trials (RCTs) published between 1966 and October 2009. <h3>Methods</h3> Data sources were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Inflammatory Bowel Disease Specialised Register and reference lists of retrieved articles. The authors included trials which compared oral 5-ASAs with either placebo or other interventions. Data extraction and assessment of methodological quality were performed independently by two reviewers. <h3>Results</h3> Ten RCTs met the inclusion criteria. Meta-analysis of the results of 8 placebo-controlled trials involving 1061 participants showed that the risk of postoperative clinical relapses was significantly reduced in patients who received oral 5-ASA compared with those who received placebo (pooled odds ratio 0.68, 95% CI 0.52 to 0.90). The incidence of adverse events was not statistically significantly different between the 5-ASA and placebo groups (pooled odds ratio 1.02, 95% CI 0.60 to 1.76). In two other studies in which oral 5-ASAs were compared with azathioprine, no statistically significant difference in clinical relapses was found but the sample sizes of these studies were small. <h3>Conclusion</h3> Oral 5-ASAs are superior to placebo for the prevention of postoperative relapses in Crohn9s disease. The authors recommend the use of 5-ASAs as maintenance therapy following surgically-induced remission in CD as they appear effective and are not associated with significant adverse events.