title: Drug therapies for ulcerative proctitis: systematic review and meta-analysis.
abstract: BACKGROUND
  Patients with ulcerative colitis limited to the proctum are considered to have ulcerative proctitis (UP). In patients with more extensive ulcerative colitis, treatment occurs in a step-up fashion (5-ASA, corticosteroids, thiopurines, anti-TNF-α agents), a strategy which has proven effective. Although treatment of UP occurs using the same step-up design, the efficacy of these therapies in UP is scarcely studied. The objectives were to systematically review the literature for randomized controlled trials studying drug therapies for induction and maintenance of remission in patients with UP.
  
  
  METHODS
  Electronic databases and reference lists of review articles were searched. The primary outcomes were clinical remission induction rate and the maintained clinical remission rate. Secondary outcomes were induction and maintenance of endoscopic and histological remission. Relative risks (RR) and 95% confidence intervals (CI) for were calculated.
  
  
  RESULTS
  Twenty-three studies (1834 patients) were included. Eighteen trials investigated induction and 5 studied maintenance of remission. Topical 5-ASA was significantly superior to placebo for induction (RR, 2.39; 95% CI, 1.63-3.51) and maintenance (RR, 2.80; 95% CI, 1.21-6.45) of clinical remission, regardless of dose or formulation. Subgroup analysis of 5-ASA suppositories also showed superiority over placebo for induction of clinical (RR, 3.07; 95% CI, 1.70-5.55) and endoscopic remission (RR, 2.64; 95% CI, 1.85-3.77).
  
  
  CONCLUSIONS
  Topical 5-ASA is superior to placebo for the induction and maintenance of clinical remission and for the induction of endoscopic remission. The efficacy of corticosteroids, thiopurines, and anti-TNFα has been insufficiently studied in patients with UP.
authors: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
authors: Mitchell R K L
authors: MR
authors: Lie
authors: Shannon L
authors: SL
authors: Kanis
authors: Bettina E
authors: BE
authors: Hansen
authors: C Janneke
authors: CJ
authors: van der Woude
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000601:surgery*; D019468:Disease Management; D006801:Humans; D011349:Proctitis / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents