Induction of Remission

Sutherland et al. [5, 6], in a meta-analysis of controlled trials, observed that 5-ASA was superior to placebo in active colitis (OR for maintaining remission 2). The same Authors, in an update of the aforementioned meta-analysis, confirmed that 5-ASA was superior to placebo for all outcome variables (global/clinical remission, global/clinical improvement, endoscopic remission or improvement).

When 5-ASA was compared to sulfasalazine, there

Table 1. Expectations expressed by members of the British National Association of Colitis and Crohn's Disease for their medical management

Before diagnosis

- Rapid access to hospital investigation

- Referral to a hospital that has a gastroenterologist specialised in IBD At diagnosis

Availability of suitable written information and audio-visual material Information about patient support groups and sources of help

Opportunity to meet non-medical members of staff, such as a clinical nurse specialist or medical social worker familiar with IBD Hospital management

Sufficient information to make a rational personal choice about treatment options Close integration of medical and surgical management

Straightforward access to support services, including dieticians, psychological support, and social workers Clearly stated management plans on discharge with well defined roles and responsibilities Outpatient management

Continuity of care, both in hospital and in primary care Patients dislike seeing different individuals at each visit A system that allows a choice about appropriate long term follow up Direct telephone access

Attention to physical, emotional, and quality of life issues

Help with problems related to insurance, employment, or social security were no differences for all the endpoints, but there was a tendency for a greater efficacy and lower side effects of 5-ASA preparations over sulfasalazine [5]. It was concluded that for their higher cost, 5-ASA preparations should be reserved for selected groups such as sulfasalazine-intolerant patients or men concerned about infertility.

The best dosage of mesalazine for inducing remission remains open to debate. Higher doses seem to produce better results, doses below 2 g/day did not show any benefit over placebo [5]. Disease extension does not influence the response to therapy in that similar responses are found in pancolitis and distal colitis [7].

Few data are available on the different outcomes concerning the efficacy of various 5-ASA formulations. Only a single study suggested that balsalazide induces more rapid clinical remission with less adverse effects compared to a pH-dependent formulation of mesalazine [8], but this requires confirmation. On the other hand, olsalazine was not superior to an enteric-coated mesalazine in inducing endoscopic remissions [9].

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