Department of Gastroenterology, Gil Medical Center, Gachon University, 405-760 1198 Guwol dong, Namdong-gu, Incheon, South Korea.
Int J Colorectal Dis. 2019 Oct;34(10):1713-1721. doi: 10.1007/s00384-019-03368-1. Epub 2019 Aug 31.
Few maintenance therapeutic options are available for inflammatory bowel disease (IBD). Data on the effects of continuing 5-aminosalicylic acid (5-ASA) treatment in patients who commence on biologics as maintenance treatment remain scarce. We evaluated IBD patient outcomes after continuation/discontinuation of 5-ASA when biologics were administered as maintenance treatment.
We retrospectively reviewed the clinical, laboratory, and imaging data of patients diagnosed with IBD (ulcerative colitis (UC), 763; Crohn's disease (CD), 537) in the Gil Medical Center (GMC) from February 2005 to June 2018. We divided patients administered with biologics as maintenance treatment into those who did and did not continue on 5-ASA and compared the efficacies of the two treatment options using the log-rank test and Cox proportional hazards models.
Of 1300 total IBD patients, 128 (UC, 63; CD, 65) were prescribed biologics as induction and maintenance treatments. The median follow-up period was 109.5 weeks. All cases were divided into those who did or did not combine 5-ASA with biologics as maintenance treatments. Kaplan-Meier analysis showed that the event-free survival (exacerbation of disease activity) of UC patients treated with biologics and 5-ASA (n = 42) was not significantly lower than that of those taking biologics alone (n = 21) (log rank test, P = 0.68). The same was true of CD patients (n = 42, biologics and 5-ASA; n = 23, biologics only) (log rank test, P = 0.87).
Continuation of 5-ASA after initiation of anti-tumor necrosis factor-alpha agents did not improve prognosis in Korean IBD patients compared with that of those who discontinued 5-ASA during maintenance treatment, particularly in patients who experienced more than two disease aggravations.
炎症性肠病（IBD）的维持治疗选择有限。关于在开始生物制剂维持治疗的患者中继续使用 5-氨基水杨酸（5-ASA）治疗的效果的数据仍然很少。我们评估了生物制剂维持治疗中继续/停止使用 5-ASA 对 IBD 患者结局的影响。
我们回顾性分析了 2005 年 2 月至 2018 年 6 月在 Gil 医疗中心（GMC）诊断为 IBD（溃疡性结肠炎（UC）763 例；克罗恩病（CD）537 例）的患者的临床、实验室和影像学数据。我们将接受生物制剂作为维持治疗的患者分为继续和不继续使用 5-ASA 的两组，并使用对数秩检验和 Cox 比例风险模型比较两种治疗选择的疗效。
在 1300 例 IBD 患者中，有 128 例（UC，63 例；CD，65 例）接受生物制剂作为诱导和维持治疗。中位随访时间为 109.5 周。所有病例均分为生物制剂联合和不联合 5-ASA 作为维持治疗的两组。Kaplan-Meier 分析显示，接受生物制剂和 5-ASA（n=42）治疗的 UC 患者的无事件生存（疾病活动恶化）并不明显低于单独使用生物制剂（n=21）的患者（对数秩检验，P=0.68）。CD 患者也如此（n=42，生物制剂和 5-ASA；n=23，生物制剂单独）（对数秩检验，P=0.87）。
与在维持治疗期间停止使用 5-ASA 的患者相比，在开始使用抗 TNF-α 药物后继续使用 5-ASA 并不能改善韩国 IBD 患者的预后，特别是在经历了两次以上疾病加重的患者中。
