Medicina Digestiva, Hospital Clínico Universitario de Valencia, España.
Rev Esp Enferm Dig. 2021 Jun;113(6):447-453. doi: 10.17235/reed.2021.7797/2021.
Aminosalicylates (5-ASA) are used as the first-line maintenance treatment in patients with mild-moderate ulcerative colitis (UC). Early identification of patients at high risk for 5-ASA non-response and appropriate therapeutic escalation are essential to avoid disease progression. However, the absence of a standardized definition for treatment success makes this a challenging task. The focus of the current review was to describe the risk factors and management strategies associated with 5-ASA non-response. Rates of 5-ASA failure can vary from 17 % to 75 % according to different success definitions, of which clinical relapse is the most prevalent and studied condition. Younger age and endoscopic activity at diagnosis, extensive colitis, early need for corticosteroids, elevated inflammatory markers and non-adherence are consistent risk factors of 5-ASA failure. Given the effectiveness, safety profile and tolerability of this medication, therapy optimization is critical before treatment escalation. Combined use of systemic and topical therapy at an appropriate dose in a once-daily administration and control of adherence could improve success rates.
氨基水杨酸（5-ASA）被用作轻度至中度溃疡性结肠炎（UC）患者的一线维持治疗。早期识别 5-ASA 无应答的高风险患者，并进行适当的治疗升级，对于避免疾病进展至关重要。然而，由于缺乏治疗成功的标准化定义，这是一项具有挑战性的任务。本综述的重点是描述与 5-ASA 无应答相关的危险因素和管理策略。根据不同的成功定义，5-ASA 失败的发生率从 17%到 75%不等，其中临床复发是最常见和研究最多的情况。较年轻的年龄和诊断时的内镜活动、广泛性结肠炎、早期需要皮质类固醇、炎症标志物升高和不依从是 5-ASA 失败的一致危险因素。鉴于这种药物的有效性、安全性和耐受性，在进行治疗升级之前，优化治疗至关重要。在每日一次的给药中，以适当的剂量联合使用全身和局部治疗，并控制依从性，可以提高成功率。
