Bibliographic record
Abstract
hen 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 If such high doses are to be used it makes sense to use a 5-ASA with little systemic absorption.Plasma 5-ASA concentrations are approximately 2 µmol/l for sulphasalazine, Pentasa, olsalazine, or balsalazide, compared with >6 µmol/l for Asacol and >13 µmol/l for Salofalk.3 As far as disease location is concerned, the key to treatment is a high concentration of 5-ASA at the site of inflammation.Suppositories are often appropriate for proctitis because >90% liquid 5-ASA enemas bypass the rectum.4 For active proctitis, a 1 g Pentasa suppository is more rapidly effective than two 500 mg Claversal (similar to Asacol) suppositories 5 and also maintains remission.6 For distal or left sided disease, suppositories can be combined with enemas.Asacol foam is better tolerated than liquid 5-ASA, while expensive Salofalk enemas provide double the necessary dose.The optimum dose for topical treatment is 1 g.7 The main role for 5-ASA remains maintenance of remission in ulcerative colitis.Individual 5-ASA derivatives all show comparable efficacy to sulphasalazine but the therapeutic advantage of the parent compound 1 should be noted.Azo bonded compounds may be better for distal disease, which predominates in ulcerative colitis, and olsalazine was better than Asacol 8 in one of the very few direct comparisons between 5-ASA derivatives.The advantage of balsalazide over Asacol 9 however, welcomed as an azo bonded compound with few side effects, has been disappointing.In any case, the theoretical advantage of azo bonded compounds for distal disease can be overcome simply by increasing the dose of mesalazine.The principal advantage of 5-ASA derivatives over sulphasalazine is that they are better tolerated.In the Cochrane review of maintenance therapy 1 however, sulphasalazine and 5-ASA had similar adverse event profiles (OR 1.16 (CI 0.62-2.16),and 1.31 (CI 0.86-1.99),respectively).The numbers needed to harm also favoured sulphasalazine, being 171 and 78, respectively.Even so, . . . . . . . . . . . .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.040 | 0.010 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".