P181 - 5-Aminosalicylic acid dependency in Crohn's disease

Abstract

Background: In the Danish Crohn Colitis Database during the treatment era of 5-Aminosalicylic acid (5-ASA), steroids and surgery, it has been revealed that 8 years from diagnosis 44% of Crohn’s disease (CD) patients were characterized with a mild disease course, 20% with an aggressive (relapse every year) and 36% with a moderate disease course (relapse every other year). Aim: The outcome of the first treatment course with 5-ASA monotherapy (1.5 4.8 g/day) was retrospectively studied in a consecutive cohort of 345 patients with CD diagnosed 1952 2007. The immediate and long-term outcome of 5-ASA treament was described. Methods: A phenotyped model was used to assess treatment response: Immediate outcome (30 days after the start of 5-ASA) was defined as Complete response: Total regression of symptoms. Partial response: Improvement of symptoms. No response: No regression of symptoms with a need to shift from 5-ASA to an immunomodulator or surgery. Longterm outcome (irrespective of the length of the treatment) was defined as: Prolonged response: Still in complete/partial remission 1 year after induction of remission (either maintained on or after cessation of 5-ASA). 5-ASA dependency: Relapse on stable/reduced dose of 5-ASA requiring dose increase to regain remission or relapse within 1 year after 5-ASA cessation regaining complete/partial response after 5-ASA reintroduction. Results: One hundred sixty-five (48%) out of 345 patients had monotherapy with 5ASA. In 50% of them 5-ASA was initiated within one year of diagnosis with a range 0 49 years. Complete or partial response was obtained in 75% and no response in 25% of patients within 30 days of treatment. Among initial responders (complete/partial response), prolonged 5-ASA response was obtained in 47% (59) of patients, 5-ASA dependency in 31% (38) and 18% (22) of patients lost initial response to 5-ASA and had to shift to surgery (73%) or immunomodulator (27%). Five patients (4%) were not assessed in long-term outcome due to short treatment couse. Female gender was associated with higher probability to develop prolonged response or 5-ASA dependency (OR 2.68, 95%CI: 1.06 6.77, p = 0.03). The median duration (range) of 5-ASA course was 34 months (1 304) in prolonged responders, 63 (6 336) in 5-ASA dependent and 5 (2 10) in non-responders. Conclusion: Patients with CD may profit from 5-ASA treatment. Seventy-eight percent of initial responders obtained long-term benefit with 31% becoming 5-ASA dependent, resulting in 5 up to 28 years of remission on 5-ASA in 50% of them. Prospective studies are warranted to assess the role of 5-ASA in CD.