Long-term clinical outcomes and factors predictive of relapse after 5-aminosalicylate or sulfasalazine therapy in patients with mild to moderate ulcerative colitis

Abstract

[한글]

[영문]Background: Clinical outcomes and factors predictive of favorable response after 5-aminosalicylates or sulfasalazine (5-ASA/sulfasalazine) treatment alone have not been well established in the treatment of mild to moderate ulcerative colitis (UC) in Asian populations. Aims: We evaluated the clinical course of Korean UC patients treated with 5-ASA/sulfasalazine as a maintenance therapy in terms of relapse and predictive factors of clinical relapse.Methods: A total 256 UC patients, treated with 5-ASA/sulfasalazine as a maintenance therapy at the outpatient clinic of the Severance Hospital between January 2000 and December 2008, were analyzed retrospectively. We sought to investigate clinical relapse rates and to determine independent predictors for relapse.Results: Of the 256 patients, 127 patients (49.6%; 71 men and 56 women) had a disease relapse during the median follow-up periods of 50 months. The cumulative relapse rate was 21.5% after 1 year, 36.5% after 2 years, 46.9% after 3 years, and 59.8% after 5 years. On multivariate analysis, left-sided or extensive colitis at diagnosis (hazard ratio, 1.46; 95% CI, 1.01-2.10; P = 0.04) and initial hemoglobin level < 10.5 g/dL (hazard ratio, 0.43; 95% CI, 0.22-0.81; P = 0.01) were found to be independent factors for clinical relapse.Conclusions: Our study showed that both disease extent at diagnosis and anemia were major predictive factors for clinical relapse after 5-ASA/sulfasalazine therapy for Korean patients with mild to moderate UC. These findings have clinical implications for identifying patients at a high risk of relapse and offering appropriate maintenance therapy.