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Remission maintenance in ulcerative colitis

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Trends in Inflammatory Bowel Disease Therapy 1999

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Abstract

From a large patient cohort it is known that about 50% of all patients with ulcerative colitis who are in a continuous supervision programme are in remission each year. However, cumulatively 90% of patients have repetitive relapses over time. While in this cohort 25% of patients had been colectomized after 10 years, more than 90%0 were able to work at the same time.

These disease characteristics indicate that continuous supervision and remission maintenance contributes to such a generally positive outcome of this disease. Furthermore no increased carcinoma risk has been found in this large cohort from Copenhagen, which further supports the use of continuous remission maintenance treatment.

Remission maintenance is indicated in all patients having definitive ulcerative colitis with the goal of decreasing the number of relapses, and to normalize carcinoma risk.

A number of drugs has been used. Initially it was shown for sulphasalazine (SASP) that at a dose of 2 g per day it reduces relapses significantly compared to placebo. A dose of 4 g per day was even better, but the difference was not considered to be clinically relevant. The newer 5-aminosalicylic acid (5-ASA) releasing drugs have been tested for remission maintenance in a number of trials. They seem to be more or less equally effective, although a recent meta-analysis has shown that sulphasalazine seems to be slightly superior. However, in the trials used for this meta-analysis only patients already known to be tolerant for sulphasalazine had been included, thereby limiting the number of side-effects in the SASP group.

For patients who have frequent relapses in spite of such treatment, or can only be brought into remission using azathioprine, this drug has also been used for remission maintenance with a relatively good success rate. The same seems to be true for patients brought into remission using cyclosporin A, although this approach has not yet been formally tested.

Currently every patient with a definitive diagnosis of ulcerative colitis in remission should be treated with either sulphasalazine or the newer 5-ASA

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Authors
  1. J. Schölmerich
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Editors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    C. N. Williams

  2. Faculty of Medicine, The Health Sciences Centre, Memorial University of Newfoundland, St John’s, Newfoundland, Canada

    R. F. Bursey

  3. Faculty of Medicine, The University of Calgary, Alberta, Canada

    D. G. Gall , L. R. Sutherland  & J. L. Wallace ,  & 

  4. University of Montreal, Canada

    F. Martin

  5. Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

    R. S. McLeod

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© 2000 Springer Science+Business Media Dordrecht

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Schölmerich, J. (2000). Remission maintenance in ulcerative colitis. In: Williams, C.N., et al. Trends in Inflammatory Bowel Disease Therapy 1999. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4002-7_12

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  • DOI: https://doi.org/10.1007/978-94-011-4002-7_12

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5769-1

  • Online ISBN: 978-94-011-4002-7

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