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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2017; 8(2): 99-102
Published online May 6, 2017. doi: 10.4292/wjgpt.v8.i2.99
5-Aminosalicylates to maintain remission in Crohn’s disease: Interpreting conflicting systematic review evidence
Morris Gordon
Morris Gordon, Department of Paediatric, Blackpool Victoria Hospital, Preston PR1 2HE, United Kingdom
Morris Gordon, School of Medicine and Dentistry, University of Central Lancashire, Preston PR1 2HE, United Kingdom
Author contributions: Gordon M was the sole author of this work.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Morris Gordon, School of Medicine and Dentistry, University of Central Lancashire, University of Central Lancashire, HA118, Harrington Building, Preston PR1 2HE, United Kingdom. morris@betterprescribing.com
Telephone: +44-7816-687791
Received: January 23, 2017
Peer-review started: January 28, 2017
First decision: March 8, 2017
Revised: March 15, 2017
Accepted: April 23, 2017
Article in press: April 25, 2017
Published online: May 6, 2017
Processing time: 100 Days and 11 Hours
Abstract

5-Aminosalicylates are a class of anti-inflammatory agents that have been used for decades in inflammatory bowel disease. Whilst they are first line for induction and an option for maintenance of remission in ulcerative colitis, the picture in Crohn’s disease is variable. For maintenance of remission, key Cochrane systematic reviews have found conflicting results between the medical and surgical induced contexts. In this piece, the possible reasons for this are considered. It is proposed that clinicians should consider 5-aminosalicylates agents an option to maintain remission post-surgery. Future primary research is needed in the medical induced remission setting which considers the length of remission on enrolment and endoscopic or histological disease scores. Additionally, secondary research to rank the various treatment options in the post-surgical setting could be achieved through the use of network meta-analysis and will guide policy makers in the future.

Keywords: 5-Aminosalicylate; Systematic review; Crohn’s disease; Inflammatory bowel disease; Cochrane

Core tip: This paper proposes that the varying length of remission and disease activity of patients enrolled in studies for medically induced remission is different to surgical induced remission and may explain differences in findings. This guides future research proposals. Future primary research is needed in the medical induced remission setting which considers the length of remission on enrolment and endoscopic or histological disease scores. Additionally, secondary research to rank the various treatment options in the post-surgical setting could be achieved through the use of network meta-analysis.