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PTH-085 The use of 5-asa in inflammatory bowel disease: national population based study
  1. V Chhaya1,
  2. S Saxena2,
  3. E Cecil2,
  4. V Subramanian3,
  5. V Curcin4,
  6. A Majeed2,
  7. R Pollok5
  1. 1Gastroenterology, St George’s Universrty Hospital
  2. 2Department of Primary Care and Public Health, Imperial College, London
  3. 3Gastroenterology, St James’ Hospital, Leeds
  4. 4Department of Primary Care and Public Health Sciences, King’s College London
  5. 5Gastroenterology, St George’s University Hospital, London, UK

Abstract

Introduction 5-aminosalicylates (5-ASA) have a proven efficacy in induction and maintenance of ulcerative colitis (UC). The evidence that 5-ASAs have efficacy in the induction and maintenance of remission in Crohn’s disease (CD) is weak and not supported by recent meta-analyses1or current guidelines. Our aim was to determine if patients with CD and UC were being appropriately prescribed 5-ASAs

Method We constructed an incident cohort of patients with CD and UC diagnosed between 1990 and 2009 using the Clinical Practice Research Datalink (CRPD), a validated research database representing an 8% sample of the UK population. We divided our cohort to compare patterns between era: era 1 (1990–1993), era 2 (1994–1997), era 3 (1998–2001), era 4 (2002–2005) and era 5 (2006–2009). We performed a Kaplan-Meier survival analysis to quantify the 3 year probability of receiving a 5-ASA. We identified patients with “prolonged 5-ASA use” defined as use for greater than 12 months duration to determine whether patients were inappropriately maintained on 5-ASAs for CD. We compared the proportion (number of users/total number within the era) of prolonged 5-ASA use between time periods using the 2-group proportion test.

Results In CD, there were 6997 patients who met our inclusion criteria. The 3 year cumulative probability of receiving a 5-ASA was 40.5% (95% CI: 35.9–45.4), 49.7% (95% CI: 45.7–53.8), 50.8% (95% CI: 48.0–53.6), 52.5% (95% CI: 50.1–54.9) and 61.8% (95% CI: 58.9–64.8) for era 1, 2, 3, 4 and 5 respectively. Prolonged oral 5-ASA use was prevalent throughout the study period in CD, although decreased between era 3 and era 5 from 59.2% to 47.2% (p < 0.001).

In UC, there were 16,512 patients who met our inclusion criteria. The 3 year cumulative probability of receiving a 5-ASA was 31.7% (95% CI: 29.3–34.3), 36.6% (95% CI: 34.3–39.0), 42.9% (95% CI: 41.0–44.7), 46.2% (95% CI: 44.6–47.8) and 55.4% (95% CI: 53.4–57.4) for era 1, 2, 3, 4 and 5 respectively. Prolonged oral 5-ASA use was increasing throughout the study period in UC, 43.3% to 53.0% between era 1 and era 4 (p < 0.001).

Conclusion In CD, 5-ASA use remains common with over 50% of patients receiving the medication, including maintenance therapy, despite a lack of evidence to support this clinical practice. In UC, 5-ASA use has increased appropriately although not all patients appeared to be maintained on these drugs.

Disclosure of interest None Declared.

Reference

  1. Ford AC, Kane S V, Khan KJ, Achkar J-P, Talley NJ, Marshall JK, Moayyedi P. Efficacy of 5-aminosalicylates in Crohn’s disease: systematic review and meta-analysis. Am J Gastroenterol 2011;106:617–29

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