title: Usefulness of sulfasalazine for patients with refractory-ulcerative colits.
abstract: BACKGROUND
  Patients with refractory-ulcerative colitis (UC) require therapy escalation. Sulfasalazine (SASP) could deliver a high concentration of 5-aminosalicylic acid to the colon. The usefulness of SASP for refractory-UC patients, however, is unclear.
  
  
  OBJECTIVE
  The aim was to evaluate the usefulness of SASP for refractory-UC patients.
  
  
  METHODS
  We retrospectively analysed 36 (11.4%) of 316 patients with refractory-UC who had been treated with SASP. Clinical and endoscopic activities were evaluated with Lichtiger index and Mayo score, respectively. We analysed the induction-remission rate, predictive factors for the efficacy of SASP, and adverse events.
  
  
  RESULTS
  Of 36 refractory-UC patients, 14 (38.9%) were treated with concomitant mesalazine enemas, 10 (27.8%) with azathiopurine, 4 (11.1%) with tacrolimus and 6 (16.7%) with an antitumour necrosis factor-α agent. After initiating SASP treatment, 25 patients (69.4%) achieved clinical remission. In 9 (64.3%) of 14 patients with UC treated with mesalazine enemas, mesalazine enemas could be discontinued with SASP. In all patients treated with tacrolimus, tacrolimus could be discontinued with SASP. Clinical activity score upon the initiation of SASP was significantly lower (p=0.024) and the number of patients treated with thiopurine was significantly higher (p=0.016) in the clinical remission group than in the non-clinical remission group. These factors might be predictive for the efficacy of SASP, although multivariate analysis demonstrated no statistically significant effect. Adverse events occurred in 7 patients (19.4%), and reduction or discontinuation of SASP led to improvement.
  
  
  CONCLUSIONS
  SASP appears to be more effective for refractory-UC patients with low clinical-activity and/or thiopurine-use.
  
  
  BACKGROUND
  UMIN000021615; Results.
authors.affiliation: Division of Gastroenterology and Hepatology , Digestive Disease Center, Kitano Hospital , Osaka , Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yoshino
authors.affiliation: Division of Gastroenterology and Hepatology , Digestive Disease Center, Kitano Hospital , Osaka , Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sono
authors.affiliation: Division of Gastroenterology and Hepatology , Digestive Disease Center, Kitano Hospital , Osaka , Japan.
authors.forename: Shujiro
authors.initials: S
authors.lastname: Yazumi
keywords: 5-AMINOSALICYLIC ACID (5-ASA); 6-MERCAPTOPURINE; AZATHIOPRINE; ULCERATIVE COLITIS