The Risk of Relapse Associated With Discontinuation of 5-Aminosalicylates in Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: Mesalamine (5-aminosalicylic acid, [5-ASA]) is the first-line therapeutic agent in mild-to-moderate ulcerative colitis (UC). The continuous use of 5-ASA involves costs, adverse effects, and delayed treatment escalation. In certain circumstances, such as in patients with Crohn disease (CD) or patients escalated to advanced therapies, discontinuation of 5-ASA may be feasible. However, the implications of withdrawal on disease outcomes remain unclear. AIMS: We sought to assess the relative risk (RR) of relapse in patients with quiescent UC or CD who discontinue 5-ASA compared with those who maintain treatment with 5-ASA. METHODS: A search of 5 databases was conducted from inception until July 2024. Eligible studies were selected and subjected to quality assessment. The studies were categorized into 6 clinically relevant cohorts, and the RR of relapse was analysed. RESULTS: A total of 7203 studies were identified, with 29 meeting inclusion criteria. The discontinuation of oral 5-ASA monotherapy was associated with a 60% increase in the risk of relapse in patients with UC (relative risk, 1.60; 95% C, 1.25-2.05; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] level of certainty, low). The withdrawal of rectal 5-ASA resulted in a RR of relapse of 2.03 (95% CI, 1.58-2.61; GRADE level of certainty, moderate). In contrast, in patients receiving immunomodulators and/or biologics, the cessation of 5-ASA was not associated with an increased risk of relapse (very low and low GRADE level of certainty, respectively). CONCLUSIONS: The discontinuation of oral or rectal 5-ASA monotherapy in patients with UC is associated with an increased risk of relapse. The data for discontinuation of 5-ASA in patients with UC or CD who are on immunomodulators and/or biologics is marginal for a meta-analysis; considering this limitation, these patients do not seem to have an increased risk of relapse upon discontinuation of 5-ASA, suggesting that monitored withdrawal may be a viable strategy.
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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 | 0.015 | 0.040 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.043 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".