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Type: Journal article
Title: Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes?
Author: Andrews, J.
Travis, S.
Gibson, P.
Gasche, C.
Citation: Alimentary Pharmacology and Therapeutics, 2009; 29(5):459-469
Publisher: Blackwell Publishing Ltd
Issue Date: 2009
ISSN: 0269-2813
Statement of
J. M. Andrews, S. P. L. Travis, P. R. Gibson and C. Gasche
Abstract: Background: With greater use of immunomodulators in inflammatory bowel disease (IBD), it is uncertain whether concurrent therapy with both 5-aminosalicylic acid [5-ASA, mesalazine (mesalamine)] and an immunomodulator is necessary. Aim: To determine whether concurrent therapy with both 5-ASA and immunomodulator(s) improves outcomes in IBD. Methods: Systematic review with search terms 'azathioprine, 6-mercaptopurine, thiopurine(s), 5 aminosalicylic acid, mesalazine, inflammatory bowel disease, ulcerative colitis, Crohn's disease, immunosuppressant(s), immunomodulator and methotrexate' in November 2007 to identify clinical trials on concurrent 5-ASA and immunomodulator therapy. Results: Two small controlled studies were found. Neither showed a benefit on disease control beyond immunomodulator monotherapy. Potential pharmacological interactions exist between 5-ASA and thiopurines. Whilst circumstantial, epidemiological and laboratory evidence suggests that 5-ASA may assist colorectal cancer (CRC) chemoprevention, it may simply be via anti-inflammatory effects. With changes in practice, ethical issues and the long lead-time needed to demonstrate or disprove an effect, no clinical studies can/will directly answer this. The costs of avoiding one CRC in IBD may be as low as 153 times the annual cost of 5-ASA therapy. Conclusions: It is unclear whether concurrent 5-ASA and immunomodulator therapy improves outcomes of disease control, drug toxicity or compliance. Concurrent therapy of 5-ASA and immunomodulators may decrease CRC risk at 'acceptable' cost.
Keywords: Humans
Inflammatory Bowel Diseases
Aminosalicylic Acids
Immunologic Factors
Treatment Outcome
Drug Therapy, Combination
Rights: © 2009 The Authors
DOI: 10.1111/j.1365-2036.2008.03915.x
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