Background

Biologic therapy has demonstrated efficacy for induction and maintenance of remission in ulcerative colitis (UC). However, it remains unclear whether oral aminosalicylates (5-ASA) should be continued or stopped after treatment escalation to biologics. The aim of the study was to evaluate differences in inflammatory biomarkers or the occurrence of complications in UC patients being treated with a combination of 5-ASA and biologics vs. biologics alone.

Methods

Retrospective study, including patients with UC and on biologic therapy with a minimum follow-up of 6 months. Collected inflammatory biomarkers were faecal calprotectin, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The occurrence of complications was defined as the need of hospitalisation, need of corticosteroids or other top-up therapy, surgery and the occurrence of dysplasia or colorectal cancer.

Results

We included 65 patients with UC, 56.9% female with a mean age of 32.8 (±12.8) years. The median follow-up was 30 (6–132) months. Regarding extension, 61.5% were E3, 35.4% E2 and 3.1% E1. While 44 patients (67.7%) were on 5-ASA and biologics (infliximab = 32, adalimumab = 6, vedolizumab = 6), 21 (32.3%) were on biologics alone (infliximab = 13, adalimumab = 3, vedolizumab = 5). The median duration of biologic therapy was 30 (6–126) months. Regarding baseline characteristics, including age, gender, duration of the disease or biologic therapy and age at UC diagnosis, there were no differences between groups. No differences regarding inflammatory biomarkers were observed – fecal calprotectin (p = 0.39), CRP (p = 0.9) and ESR (p = 0.61). No differences were found regarding complications, namely the need of hospitalisation (p = 0.06) or need of corticosteroids (p = 0.89). Only one patient developed dysplasia (under infliximab and 5-ASA). Any of the included patients needed surgery or developed colorectal cancer.

Conclusion

About two-thirds of the UC patients under biologics are co-treated with 5-ASA. No differences between UC patients under combination biologics+5-ASA vs. biologics alone were found regarding inflammatory biomarkers or the occurrence of complications. These results raise the question if continuing 5-ASA in UC patients under biologics is really necessary.

中文翻译：

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P562 5-ASA在溃疡性结肠炎中：在生物治疗时代是否真的需要它们？

背景

生物疗法已证明可诱导和维持溃疡性结肠炎（UC）缓解的功效。然而，尚不清楚在将治疗升级为生物制剂后是否应继续或停止口服氨基水杨酸酯（5-ASA）。该研究的目的是评估用5-ASA和生物制剂与单独使用生物制剂组合治疗的UC患者的炎症生物标志物差异或并发症的发生。

方法

回顾性研究，包括UC患者和接受生物治疗的患者，至少随访6个月。收集的炎性生物标志物是粪便钙卫蛋白，C反应蛋白（CRP）和红细胞沉降率（ESR）。并发症的发生被定义为需要住院治疗，需要皮质类固醇或其他补充疗法，手术以及不典型增生或结直肠癌的发生。

结果

我们纳入了65例UC患者，女性为56.9％，平均年龄为32.8（±12.8）岁。中位随访时间为30（6-132）个月。在扩展方面，E3为61.5％，E2为35.4％，E1为3.1％。44例（67.7％）患者接受5-ASA和生物制剂治疗（英夫利昔单抗= 32，阿达木单抗= 6，维多珠单抗= 6），而21例（32.3％）仅接受生物制剂治疗（英夫利昔单抗= 13，阿达木单抗= 3，维多珠单抗= 5） 。生物治疗的中位时间为30（6-126）个月。关于基线特征，包括年龄，性别，疾病或生物疗法的持续时间以及UC诊断时的年龄，两组之间没有差异。没有观察到关于炎症生物标志物的差异–粪钙卫蛋白（p = 0.39），CRP（p = 0.9）和ESR（p = 0.61）。没有发现并发症，即需要住院治疗的差异（p = 0。06）或需要皮质类固醇（p = 0.89）。仅一名患者发生异型增生（在英夫利昔单抗和5-ASA下）。纳入的任何患者都需要手术或发展为大肠癌。

结论

接受生物制剂治疗的UC患者中约有三分之二与5-ASA共同治疗。联合生物制剂+ 5-ASA的UC患者与单独使用生物制剂的UC患者在炎症生物标志物或并发症的发生方面没有差异。这些结果提出了一个问题，即是否真的有必要在生物制剂治疗下对UC患者继续使用5-ASA。