In An Evidence-Based Systematic Review on Medical Therapies for Infl ammatory Bowel Disease by Nicholas J. Talley , MD, PhD, FACG 1 , Maria T. Abreu , MD, FACG 2 , Jean-Paul Achkar , MD, FACG 3 , Charles N. Bernstein , MD, FACG 4, Marla C. Dubinsky , MD 5 , Stephen B. Hanauer , MD, FACG 6 , Sunanda V. Kane , MD, MSPH, FACG 7 , William J. Sandborn , MD, FACG 8 ,
Thomas A. Ullman , MD, FACG 9 and Paul Moayyedi , MB, ChB, BSc, MPH, PhD, FACG 10 for the American College of Gastroenterology IBD Task Force [SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg
] published in Am J Gastroenterol 2011; 106:S2 – S25; doi: 10.1038/ajg.2011.58
on inducing remission with 5-ASAs: "...Overall we recommended against using 5-ASA to induce remission in active CD. Th e reason for this was that the data were equivocal and this did not include the Crohn’s III trial (160) involving 310 patients. Data on CD remission or improvement were not available for this trial, but the mean CDAI scores were similar between 5-ASA and placebo arms (160), suggesting that this trial is likely to be negative. Given that this trial represents 33 % of all the patients in the meta-analysis, we felt that it was likely that 5-ASA was not effective at inducing remission in active CD. 5-ASA therapies are likely to be maximally eff ective in the colon and yet the majority of patients in the studies analyzed had either ileal or ileocolonic disease. Th equality of evidence was categorized as low as there was only one trial (159) with low risk of bias, results were heterogeneous, and conclusions were different depending on what outcome measure was chosen."
on maintaining remission with 5-ASAs: "There were 16 RCTs (155,159,161 – 174) assessing 2,496 patients comparing 5-ASA with placebo or no therapy in quiescent CD for 6 to 48 months. The majority of patients had ileal or ileocolonic disease and there was no signifi cant diff erence in relapse rates between the two groups. The overall relapse rate was 56 % with 5-ASA therapies and 57 % in the control group (100). In the 11 trials that evaluated mesalamine, there was a trend toward benefit of 5-ASA, but this was not statistically significant (100). There were only three trials (155,165,170) that had low risk of bias and a subgroup analysis of these studies suggested a small but statistically signifi cant benefit of 5-ASA at preventing CD relapse (NNT = 13; 95 % CI: 6 – 100). Th e evidence was of low quality as there was a paucity of trials that had a low risk of bias, there was unexplained heterogeneity between studies and conclusions differed in those with unclear vs. low risk of bias. Overall the evidence available was not sufficient to recommend 5-ASA therapies to prevent CD relapse. Unlike the recommendation of the Cochrane review (91), we concluded that further trials might
be helpful in determining whether 5-ASA therapies have a role in colonic CD."
and from the concluding paragraph: "These data highlight that there are a paucity of options for patients with mild CD who require maintenance therapy...."