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2693 pages added, reviewed or updated during the last month (last updated: 14/4/2021)


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aminosalicylates in Crohn's disease

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Aminosalicylate drugs, particularly mesalazine, may be used for the induction and maintenance of remission in Crohn's disease.

  • efficacy of aminosalicylates is small, especially if disease is limited to the ileum
  • meta-analysis indicates that aminosalicylates probably only reduce the risk of relapse by about 1/3 in contrast to the 2/3 reduction in relapse rate that is seen with maintenance therapy with aminosalicylates in UC
  • patients who relapse on aminosalicylates will need steroid treatment
  • the clinical effect of this class of agent is mediated by inhibiting multiple mediators of inflammation, including cytokines, platelet activating factor and possibly leukotriene B4

European evidence-based consensus group and a Cochrane systematic review haven’t found any evidence that aminosalicylates (such as mesalazine) are superior to placebo at maintaining remission in people with medically-induced remission of Crohn’s disease (1).

Mesalazine has been found to reduce relapses after surgery (especially after small bowel resection) (2).

NICE state (3):

  • inducing remission in Crohn's disease
    • use of 5-ASA for inducing remission in Crohn's disease
      • in people who decline, cannot tolerate or in whom glucocorticosteroid treatment is contraindicated, consider 5-aminosalicylate (5-ASA) treatment for a first presentation or a single inflammatory exacerbation in a 12-month period

  • maintaining remission in Crohn's disease after surgery

    • consider 5-ASA treatment to maintain remission after surgery

Reference:

Last reviewed 01/2018

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