February 24, 2017
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High-dose mesalamine effective as alternative induction therapy for mild-to-moderate Crohn's disease

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Among different induction therapies for mild-to-moderate Crohn’s disease, corticosteroids and high-dose budesonide were both effective, and high-dose mesalamine was an effective alternative, according to the results of a Bayesian network meta-analysis.

“Physicians and patients have many options in treating mild to moderately active Crohn’s disease,” Gilaad G. Kaplan, MD, MPH, from the departments of medicine and community health sciences at University of Calgary in Canada, told Healio Gastroenterology. “While corticosteroids are effective in treating Crohn’s disease, patients often prefer to avoid prednisone due to potential systemic toxicities.”

Gilaad G. Kaplan, MD, MPH

Gilaad G. Kaplan

To compare the proportion of patients who achieved induction of remission with different therapeutic options, Kaplan and colleagues reviewed randomized controlled trial data published up to November 2015, and ultimately analyzed 22 trials comparing budesonide, sulfasalazine, mesalamine or corticosteroids with each other or placebo. They also stratified mesalamine and budesonide into low and high doses.

They found that corticosteroids were the most effective compared with placebo (OR = 3.8; 95% CI, 2.48-5.66) followed by high-dose budesonide above 6 g daily (OR = 2.96; 95% CI, 2.06-4.3).

“Consistent with practice guidelines, our network meta-analysis demonstrated that budesonide was an effective and safe therapy to induce remission in mild to moderately active Crohn’s disease,” Kaplan said.

Furthermore, they found that high-dose mesalamine was superior to placebo for induction of remission (OR = 2.29; 95% CI, 1.58-3.33).

“The use of mesalamine for Crohn’s disease has fallen out of favor in certain guidelines. However, we determined that high dose mesalamine (>2.4 g per day) was superior to placebo in inducing remission in Crohn’s disease,” Kaplan said. “Mesalamine may be considered an alternative therapy in patients with mildly active Crohn’s disease seeking to avoid steroids.”

While corticosteroids were comparably effective to high-dose budesonide (OR = 1.21; 95% CI, 0.84–1.76), they were more effective than high-dose mesalamine (OR = 1.83; 95% CI, 1.16–2.88). Finally, they found that sulfasalazine was not significantly more effective than other therapies or placebo.

The investigators concluded that budesonide and prednisone have demonstrated consistent effectiveness for treating Crohn’s disease, and called for head-to-head randomized controlled trials “to clarify the role of mesalamine in the treatment of active mild-to-moderate Crohn’s disease.” – by Adam Leitenberger

Disclosures: Kaplan reports he has served as a speaker for Janssen, Merck, Schering-Plough, AbbVie, and UCB Pharma, has participated in advisory board meetings for Janssen, AbbVie, Merck, Schering-Plough, Shire, and UCB Pharma, and has received research support from Merck, AbbVie, GlaxoSmithKline, and Shire. Please see the full study for a list of all other researchers’ relevant financial disclosures.