Andrews J M, Travis S P L, Gibson P R, Gasche C
Departments of Gastroenterology and Hepatology, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia.
Aliment Pharmacol Ther. 2009 Mar 1;29(5):459-69. doi: 10.1111/j.1365-2036.2008.03915.x. Epub 2008 Dec 11.
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.
To determine whether concurrent therapy with both 5-ASA and immunomodulator(s) improves outcomes in IBD.
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.
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.
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.
随着免疫调节剂在炎症性肠病（IBD）中的使用增加，5-氨基水杨酸[5-ASA，美沙拉嗪（5-氨基水杨酸）]与免疫调节剂联合治疗是否必要尚不确定。
确定5-ASA与免疫调节剂联合治疗是否能改善IBD的治疗效果。
2007年11月进行系统综述，检索词为“硫唑嘌呤、6-巯基嘌呤、硫嘌呤类、5-氨基水杨酸、美沙拉嗪、炎症性肠病、溃疡性结肠炎、克罗恩病、免疫抑制剂、免疫调节剂和甲氨蝶呤”，以确定关于5-ASA与免疫调节剂联合治疗的临床试验。
发现两项小型对照研究。两者均未显示出比单一免疫调节剂治疗在疾病控制方面更具优势。5-ASA与硫嘌呤类之间存在潜在的药物相互作用。虽然间接的、流行病学和实验室证据表明5-ASA可能有助于结直肠癌（CRC）的化学预防，但这可能仅仅是通过抗炎作用。随着实践的变化、伦理问题以及证明或反驳一种效果所需的漫长时间，没有临床研究能够/将会直接回答这个问题。在IBD中避免一例CRC的成本可能低至5-ASA治疗年成本的153倍。
尚不清楚5-ASA与免疫调节剂联合治疗是否能改善疾病控制效果、药物毒性或依从性。5-ASA与免疫调节剂联合治疗可能以“可接受”的成本降低CRC风险。
