Rectal 5-Aminosalicylic Acid for Induction of Remission in Distal Ulcerative Colitis

A Cochrane review[Abstract] 1 included 38 studies with a total of 4 734 subjects with ulcerative colitis and a distal disease margin less than 60 cm from the anal verge or distal to the splenic flexure. Rectal 5-ASA was superior to placebo for inducing symptomatic (OR 8.87, 95% CI 5.30 to 14.83; 8 studies, n=811), endoscopic (OR 11.18, 95% CI 5.99 to 20.88; 5 studies, n=331), and histological (OR 7.69, 95% CI 3.26 to 18.12; 6 studies, n=452) improvement, symptomatic remission (OR 8.30, 95% CI 4.28 to 16.12; 8 studies, n=756), endoscopic remission (OR 5.31, 95% CI 3.15 to 8.92; 7 studies, n=729), and histologic remission (OR 6.28, 95% CI 2.74 to 14.40; 5 studies, n=588).

Rectal 5-ASA was superior to rectal corticosteroids for inducing symptomatic improvement (OR 1.56, 95% CI 1.15 to 2.11; 9 studies, n=937) and remission (OR 1.65, 95% CI 1.11 to 2.45; 6 studies, n=942). Rectal 5-ASA was not statistically superior to oral 5-ASA for symptomatic improvement (OR 2.25, 95% CI 0.53 to 9.54; 4 studies, n=214). Neither total daily dose nor 5-ASA formulation affected treatment response.

Strong recommendation: Use rectal 5-ASA as first-line therapy for patients with mild to moderately active distal ulcerative colitis who are willing to use rectal therapies.

The following decision support rules contain links to this evidence summary:

• Rectal 5-ASA rather than rectal corticosteroids for ulcerative proctitis or colitis http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00517&country=UK

References

• Marshall JK, Thabane M, Steinhart AH, Newman JR, Anand A, Irvine EJ. Rectal 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2010;(1):CD004115. [PubMed]