The use of 5-aminosalicylate for patients with Crohn's disease in a prospective European inception cohort with 5 years follow-up - an Epi-IBD study

Johan Burisch , Daniel Bergemalm (1) , Jonas Halfvarson (1) , Viktor Domislovic (2) , Zeljko Krznaric (2, 3) , Adrian Goldis (4) , Jens F. Dahlerup (5) , Pia Oksanen (6, 7) , Pekka Collin (7) , Luisa De Castro (8) , Vicent Hernandez (8) , Svetlana Turcan (9) , Elena Belousova (10) , Renata d'Inca (11) , Alessandro Sartini (12) , Daniela Valpiani (12) , Martina Giannotta (13) , Ravi Misra (14) , Naila Arebi (14) , Dana Duricova (15, 16) , Martin Bortlik (15, 16) , Kelly Gatt (17) , Pierre Ellul (17) , Natalia Pedersen , Jens Kjeldsen (18) , Karina W. Andersen (19) , Vibeke Andersen (19) , Konstantinos H. Katsanos (20) , Dimitrios K. Christodoulou (20) , Shaji Sebastian (21) , Luisa Barros (22) , Fernando Magro (22, 23) , Jongero M. M. Midjord (24) , Kari R. Nielsen (24) , Riina Salupere (25) , Hendrika A. L. Kievit (26) , Gediminas Kiudelis (27) , Juozas Kupcinskas (27) , Mathurin Fumery (28) , Corinne Gower-Rousseau (29, 30, 31) , Ioannis P. Kaimakliotis , Doron Schwartz (32) , Selwyn Odes (32) , Laszlo Lakatos , Peter L. Lakatos (33, 34) , Ebbe Langholz (35) , Pia Munkholm

1 Örebro University
2 University Hospital Centre Zagreb
3 University of Zagreb
4 UMFT - Victor Babeş University of Medicine and Pharmacy
5 Aarhus University Hospital
6 Tampere University Hospital
7 University of Tampere [Finland]
8 Complexo Hospitalario Universitario de Vigo
9 Université d'Etat de Médecine et Pharmacie, Chisinau, Republic of Moldova
10 MONICA - Moscow Regional Research Clinical Institute
11 Unipd - Università degli Studi di Padova = University of Padua
12 G.B. Morgagni-Pierantoni Hospital [Forlì, Italy]
13 Azienda Usl Toscana centro [Firenze]
14 Imperial College London
15 IBD clinical and research centre, ISCARE, Prague, Czech Republic
16 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
17 Mater Dei Hospital [Malta]
18 OUH - Odense University Hospital
19 SDU - University of Southern Denmark
20 University Hospital of Ioannina
21 University of Hull [United Kingdom]
22 Centro Hospitalar Universitário de São João [Porto]
23 Universidade do Porto = University of Porto
24 National Hospital of the Faroe Islands [Tórshavn, Faroe Islands]
25 University of Tartu
26 Herning Hospital
27 LSMU - Lithuanian University of health Sciences
28 CHU Amiens-Picardie
29 Service d'Epidémiologie et de Santé Publique [Lille]
30 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
31 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
32 BGU - Ben-Gurion University of the Negev
33 Semmelweis University [Budapest]
34 MUHC - McGill University Health Center [Montreal]
35 UCPH - University of Copenhagen = Københavns Universitet

Background The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. Aims The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. Methods In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. Results Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). Conclusion In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.

Mots clés: Population-based cohort; 5-aminosalicylates; disease course

Domaines: Sciences du Vivant [q-bio]

Johan Burisch, Daniel Bergemalm, Jonas Halfvarson, Viktor Domislovic, Zeljko Krznaric, et al.. The use of 5-aminosalicylate for patients with Crohn's disease in a prospective European inception cohort with 5 years follow-up - an Epi-IBD study. United European Gastroenterology Journal, 2020, 8 (8), pp.949-960. ⟨10.1177/2050640620945949⟩. ⟨hal-03551526⟩