Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes?
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 imm...
| Main Authors: | , , , |
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| Format: | Journal article |
| Language: | English |
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2009
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| _version_ | 1797088781867679744 |
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| author | Andrews, J Travis, S Gibson, P Gasche, C |
| author_facet | Andrews, J Travis, S Gibson, P Gasche, C |
| author_sort | Andrews, J |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-07T02:54:59Z |
| format | Journal article |
| id | oxford-uuid:aef4c820-fbde-4fe8-9ce9-a03da4b9ddb1 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:54:59Z |
| publishDate | 2009 |
| record_format | dspace |
| spelling | oxford-uuid:aef4c820-fbde-4fe8-9ce9-a03da4b9ddb12022-03-27T03:46:21ZSystematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:aef4c820-fbde-4fe8-9ce9-a03da4b9ddb1EnglishSymplectic Elements at Oxford2009Andrews, JTravis, SGibson, PGasche, C 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. |
| spellingShingle | Andrews, J Travis, S Gibson, P Gasche, C Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? |
| title | Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? |
| title_full | Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? |
| title_fullStr | Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? |
| title_full_unstemmed | Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? |
| title_short | Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? |
| title_sort | systematic review does concurrent therapy with 5 asa and immunomodulators in inflammatory bowel disease improve outcomes |
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