A Survey On 5-aminosalicylic Acid In The Treatment Of Crohn’s Disease

Objective: Although neither international nor Chinese guidelines did recommend 5-ASA in treatment of Crohn’s disease(CD),this may not be the case in clinical practice.This study was aimed to investigate the views of IBD clinicians on 5-ASA in treatment CD.Methods: A questionnaire including 21 items were performed among Chinese IBD physicians by We Chat.And the actual utilization of 5-ASA was retrospectively analyzed in CD patients at the First Affiliated Hospital of Fujian Medical University from January 2013 to September 2020.Results:1.A total of 615 questionnaires were taken bake,of which 90.4% of the respondents said that they had prescribed 5-ASA for CD patients.The 5-ASA was mainly prescribed for the patients with mild active disease(91.7%),colonic location(77.9%)and non-stenosis and non-penetrating disorder(91.4%).58.1% physicians prescribed 5-ASA for CD induction therapy,of whose 71.5% used a dose of 3-4g/d(excluding 3g)5-ASA and 89.2% combined with other drugs(90.3% physicians combined with Corticosteroid).83.1% physicians prescribed 5-ASA for maintenance therapy in patients with medically-or surgically-induced remission.Good safety(75.5%),evidence of efficacy in mild disease and in patient subgroups not subjected to randomized controlled trials(68.2%),and relatively lower cost were the main reasons for physicians to use 5-ASA.2.A total of 560 CD patients were included in this study,of whose 414 patients(73.9%)were prescribed with 5-ASA(Group 5-ASA)and 146(26.1%)without 5-ASA(Group non-5-ASA).Compared to those in Group non-5-ASA,more female(17.1% VS 31.4%,P=0.001),more older at CD diagnosed(23 years VS 27years old,P=0.002),more longer of disease course(2 year VS 4 year,P=0.001),more ileocolonic lesions(43.2% VS 57.7%,P<0.001),and less perianal lesions(49.3% VS 59.6%,P=0.032),less perianal fistulas(37.2% VS 54.1%,P<0.001)and less perianal surgery(33.1% VS 42.8%,P=0.044)in the Group 5-ASA.Multivariable logistic regression analysis showed that females(OR=1.779,95%CI:1.083～2.922),disease course≧10 years(OR=3.998,95%CI:1.655～9.662),colonic lesion(OR=2.270,95%CI:1.328～3.881)and no CD-related surgery(OR=0.555,95%CI:0.372,0.829)were positively associated with usage of 5-ASA(P<0.05).There was no increase in the risk of CD-associated adverse events after withdrawing 5-ASA after upgrading to IFX or azathioprine treatment(p>0.05).Conclusions: Although neither international nor Chinese guidelines did recommend5-ASA in treatment of CD,5-ASA were still widely prescribed for CD patients in clinical practice.Female colonic CD without perianal lesions was the main factor to choose 5-ASA,which may be an early transitional treatment after the diagnosis of CD.