Introduction: For 30 years, 5-aminosalicylic acid (5-ASA) has been the backbone of therapeutic management in patients with ulcerative colitis (UC). In the biologic era, it still remains the treatment of choice in mild-to-moderate UC. Positioning of this therapeutic class in moderate-to-severe UC is less clear. Areas covered: Several studies demonstrated the ability of 5-ASA to induce endoscopic remission to a similar extent as anti-TNF therapy on the moderate segment of UC. Histologic remission is achieved after induction in up to 45% of patients treated with topical 5-ASA and 30% with oral formulations. Aminosalicylates offer a favorable safety profile compared to that of immunomodulators and biologics. High-dose 5-ASA therapy may be a valuable option for patients with moderately active disease, and physicians should weigh the pros and cons of this strategy in selected patients. Whether aminosalicylates should be continued in combination with thiopurines or biologic therapy remains under debate. Expert opinion: In the era of biologics, aminosalicylates remain the first-line therapy in patients with mild UC, and have to be considered in case of moderate UC, given their favorable risk-benefit profile. We suggest that 5-ASA should be used in moderate patients without poor prognostic factors, while biologics should be preferred otherwise.

中文翻译：

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5-氨基水杨酸化合物在溃疡性结肠炎中的现代应用。

简介：30年以来，5-氨基水杨酸（5-ASA）一直是溃疡性结肠炎（UC）患者治疗管理的骨干。在生物时代，它仍然是轻度至中度UC的首选治疗方法。在中度至重度UC中这种治疗类别的定位尚不清楚。涵盖的领域：多项研究表明，5-ASA可以在中度UC上诱导内镜缓解的能力与抗TNF治疗相似。诱导后高达45％的局部5-ASA治疗患者和30％口服制剂的患者达到组织学缓解。与免疫调节剂和生物制剂相比，氨基水杨酸酯具有良好的安全性。大剂量的5-ASA治疗对于中度活动性疾病的患者可能是一种有价值的选择，并且医生应权衡此策略在特定患者中的利弊。是否应继续与氨基嘌呤类药物联合继续使用氨基水杨酸酯或生物疗法尚有争议。专家意见：在生物制剂时代，氨基水杨酸酯仍然是轻度UC患者的一线治疗，鉴于其有益的风险获益，在中度UC患者中必须考虑使用。我们建议5-ASA应该用于没有不良预后因素的中度患者，否则应首选生物制剂。鉴于其良好的风险收益特征，在中度UC情况下必须予以考虑。我们建议5-ASA应用于没有不良预后因素的中度患者，否则应首选生物制剂。鉴于其良好的风险收益特征，在中度UC情况下必须予以考虑。我们建议5-ASA应该用于没有不良预后因素的中度患者，否则应首选生物制剂。