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Which 5-ASA?
  1. S P L Travis
  1. John Radcliffe Hospital, Oxford OX3 9DU, UK;

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When Asacol commands 65% of the UK market, can so many British gastroenterologists be wrong? Possibly. The market leader in France is Pentasa (72%) and is Salofalk in Germany (57%). In Canada it is Asacol (46%). Nevertheless, a Cochrane review of 11 trials involving 1598 patients showed that sulphasalazine was more effective than other 5-aminosalicylic acid (5-ASA) drugs for maintaining remission in ulcerative colitis (odds ratio (OR) 1.29, confidence interval (CI) 1.06–1.57).1 Diagnosis, disease location, activity, side effect profile, efficacy, and cost all affect the choice of 5-ASA.

5-ASA acts on and is metabolised by intestinal epithelial cells. Consequently, ulcerative colitis (a mucosal disease) is more susceptible to treatment by 5-ASA than transmural Crohn's disease. Mega doses of mesalazine (≥4 g/day) may be an initial alternative to steroids for mild-moderately active ulcerative colitis and reduce the risk of relapse after small intestinal (but not colonic) resection for Crohn's disease.2 …

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  • Conflict of interest. Dr Travis has cheerfully enjoyed hospitality from all manufacturers of 5-ASA derivatives and has done advisory work for Ferring Pharmaceuticals, Pharmacia, and SmithKline Beecham.