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Oral 5-ASAs for ulcerative colitis may be less effective than topical or combined therapy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Treatment with combined oral and topical 5-aminosalicylates (5-ASAs) is more likely than oral therapy alone to achieve remission of ulcerative colitis (UC). That’s one finding from a meta-analysis reported in the American Journal of Gastroenterology online November 22.

“There was also some evidence to suggest that intermittent topical therapy was superior to oral 5-ASAs for preventing relapse of quiescent UC,” the authors found.

Dr. Alexander C. Ford, with Leeds General Infirmary in the UK, and colleagues point out that 5-ASAs are the mainstay of treatment for many patients with ulcerative colitis, but the relative efficacies of oral, topical or combined oral and topical 5-ASA therapy “remain relatively unknown.”

They therefore conducted a systematic review of the literature and identified 12 randomized clinical trials examining the effects of different routes of administration of 5-ASAs in adults with active or quiescent ulcerative colitis.

In the case of active disease, the pooled data indicated failure to induce remission was significantly less likely with combined oral and topical 5-ASAs than with oral therapy alone (relative risk, 0.65), the investigators found. The number-needed-to-treat (NNT) with combined 5-ASA therapy to prevent one patient failing to achieve remission was 5.

The relative risk of failure to achieve remission with topical versus oral 5-ASAs was 0.82, but this was not statistically significant, the report indicates.

For maintenance therapy of quiescent ulcerative colitis, the risk of relapse was significantly less with intermittent topical therapy than with daily oral therapy, the analysis showed. The relative risk 0.64, and the NNT with intermittent topical therapy to prevent one relapse was 4.

While the relative risk of relapse with combined therapy versus oral therapy was 0.48, this was not statistically significant as the result was based on a total of just 96 patients, according to the report.

In fact, Dr. Ford and colleagues caution that the total amount of data contributing to their analysis was limited. They conclude: “Further trials of higher quality, which study the relative efficacy of oral vs. topical 5-ASA therapy, and oral vs. combined oral and topical 5-ASAs, for both the induction of remission and prevention of relapse of UC, as well as examining patient preferences on routes of administration for 5-ASAs in these two situations, are required.”

Reference:

Am J Gastroenterol 2011