title: Oral 5-aminosalicylic acid for inducing remission in ulcerative colitis.
abstract: OBJECTIVE
  To assess the efficacy, dose-responsiveness and safety of the newer release formulations of 5-aminosalicylic acid (5-ASA) compared to placebo or sulfasalazine (SASP) for the induction of remission in active ulcerative colitis.
  
  
  METHODS
  A computer-assisted literature search for relevant studies (1981-1998) was performed using MEDLINE, BIOS, the Cochrane Controlled Trials Register and the Science Citation Index, followed by a manual search of reference lists from previously retrieved articles, review articles, symposia proceedings, and abstracts from major gastrointestinal conferences.
  
  
  METHODS
  Studies were accepted for analysis if they were randomized, double-blinded, and controlled clinical trials of parallel design, with treatment durations of a minimum of four weeks.
  
  
  METHODS
  Based on an intention to treat principle, the outcomes of interest in the treatment of active disease were the failure to induce global/clinical remission, global/clinical improvement, endoscopic remission, or endoscopic improvement.
  
  
  RESULTS
  5-ASA was superior to placebo with regard to all measured outcome variables. For the failure to induce global/clinical improvement or remission, the pooled Peto odds ratio was 0.51 (95% CI, 0.35 to 0.76). A dose-response trend for 5-ASA was also observed. When 5-ASA was compared to SASP, the pooled Peto odds ratio was 0.87 (CI, 0.63 to 1.21) for the failure to induce global/clinical improvement or remission, and 0.66 (CI, 0.42 to 1.04) for the failure to induce endoscopic improvement. SASP was not as well tolerated as 5-ASA.
  
  
  CONCLUSIONS
  The newer 5-ASA preparations were superior to placebo and tended towards therapeutic benefit over SASP. However, considering their relative costs, a clinical advantage to using the newer 5-ASA preparations in place of SASP appears unlikely.
authors.affiliation: Division of Gastroenterology, University of Calgary, Foothills Hospital, 1751 3330 Hospital Drive N W, Calgary, AB, Canada, T2N 4N1. lsutherl@acs.ucalgary.ca
authors.forename: L
authors.initials: L
authors.lastname: Sutherland
authors.forename: D
authors.initials: D
authors.lastname: Roth
authors.forename: P
authors.initials: P
authors.lastname: Beck
authors.forename: G
authors.initials: G
authors.lastname: May
authors.forename: K
authors.initials: K
authors.lastname: Makiyama
mesh_terms: D000636:Aminosalicylic Acids / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D006801:Humans; D012074:Remission Induction; D012460:Sulfasalazine / Q000627:therapeutic use
chemical_list: D000636:Aminosalicylic Acids; D012460:Sulfasalazine