title: [Rescue therapy with sulfasalazine prior to immunosuppressive or biological agents in ulcerative colitis poorly controlled with mesalazine].
abstract: BACKGROUND
  In ulcerative colitis, aminosalicylates are the mainstay of maintenance therapy. Sulfasalazine was the first aminosalicylic used in the maintenance therapy of this disease. Later, mesalazine was preferred due to its supposedly better tolerability. However, recent studies indicate certain benefits of the use of sulfasalazine because of its possible superior effectiveness. The aim of this study was to determine whether patients with ulcerative colitis poorly controlled by mesalazine as maintenance therapy respond to sulfasalazine, thus avoiding the use of immunosuppressive or biological therapies.
  
  
  METHODS
  The Inflammatory Bowel Disease Clinic of the Ramón y Cajal Hospital maintains a database in which all drug exposures are registered. We selected patients poorly controlled with mesalazine who had received sulfasalazine as rescue maintenance therapy. We determined the percentage of patients poorly controlled with mesalazine who responded to sulfasalazine.
  
  
  RESULTS
  Of 415 patients with ulcerative colitis, 49 had been treated with sulfasalazine at some time. Of these, sulfasalazine was selected as an alternative therapy due to poor disease control with mesalazine. The median duration of mesalazine therapy until the switch was 20.8 months, with a median dose of 3.35 g/day. In 21 of the 31 patients (67.7%), sulfasalazine was able to control symptoms and maintain remission.
  
  
  CONCLUSIONS
  Despite the limitations of this study, we found that 67.7% of patients with ulcerative colitis poorly controlled with mesalazine responded to a switch to sulfasalazine. These patients would normally have progressed to immunosuppressive, biological or surgical treatments. This option merits further studies. Meanwhile sulfasalazine should not be forgotten in the management of ulcerative colitis.
authors.affiliation: Servicio de Gastroenterología, Hospital Ramón y Cajal, Madrid, España. martinez.gonzalez.javier@gmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Martínez González
authors.forename: Victoria
authors.initials: V
authors.lastname: Busto Bea
authors.forename: Francisco
authors.initials: F
authors.lastname: Mesonero Gismero
authors.forename: Sofía
authors.initials: S
authors.lastname: Parejo Carbonell
authors.forename: Elena
authors.initials: E
authors.lastname: Garrido
authors.forename: Antonio
authors.initials: A
authors.lastname: López San Román
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001685:Biological Factors / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D012189:Retrospective Studies; D012460:Sulfasalazine / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001685:Biological Factors; D007166:Immunosuppressive Agents; D012460:Sulfasalazine; D019804:Mesalamine