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Modelling the benefits of an optimised treatment strategy for 5-ASA in mild-to-moderate ulcerative colitis

Authors
 Edouard Louis  ;  Kristine Paridaens  ;  Sameer Al Awadhi  ;  Jakob Begun  ;  Jae Hee Cheon  ;  Axel U Dignass  ;  Fernando Magro  ;  Juan Ricardo Márquez  ;  Alexander R Moschen  ;  Neeraj Narula  ;  Grazyna Rydzewska  ;  Matthew J Freddi  ;  Simon Pl Travis 
Citation
 BMJ OPEN GASTROENTEROLOGY, Vol.9(1) : e000853, 2022-02 
Journal Title
BMJ OPEN GASTROENTEROLOGY
ISSN
 * 
Issue Date
2022-02
MeSH
Administration, Oral ; Anti-Inflammatory Agents, Non-Steroidal / adverse effects ; Anti-Inflammatory Agents, Non-Steroidal / therapeutic use ; Biological Products* / therapeutic use ; Colitis, Ulcerative* / chemically induced ; Colitis, Ulcerative* / drug therapy ; Humans ; Mesalamine / adverse effects ; Mesalamine / therapeutic use ; Neoplasm Recurrence, Local / chemically induced ; Neoplasm Recurrence, Local / drug therapy ; Remission Induction ; Sulfasalazine / adverse effects
Keywords
5-aminosalicylic acid (5-asa) ; inflammatory bowel disease ; ulcerative colitis
Abstract
Objectives: 5-aminosalicylate (mesalazine; 5-ASA) is an established first-line treatment for mild-to-moderate ulcerative colitis (UC). This study aimed to model the benefits of optimising 5-ASA therapy.

Methods: A decision tree model followed 10 000 newly diagnosed patients with mild-to-moderately active UC through induction and 1 year of maintenance treatment. Optimised treatment (maximising dose of 5-ASA and use of combined oral and rectal therapy before treatment escalation) was compared with standard treatment (standard doses of 5-ASA without optimisation). Modelled data were derived from published meta-analyses. The primary outcomes were patient numbers achieving and maintaining remission, with an analysis of treatment costs for each strategy conducted as a secondary outcome (using UK reference costs).

Results: During induction, there was a 39% increase in patients achieving remission through the optimised pathway without requiring systemic steroids and/or biologics (6565 vs 4725 for standard). Potential steroidal/biological adverse events avoided included: seven venous thromboembolisms and eight serious infections. Out of the 6565 patients entering maintenance following successful induction on 5-ASA, there was a 21% reduction in relapses when optimised (1830 vs 2311 for standard). This translated into 297 patients avoiding further systemic steroids and 214 biologics. Optimisation led to an average net saving of £272 per patient entering the model for the induction and maintenance of remission over 1 year.

Conclusion: Modelling suggests that optimising 5-ASA therapy (both the inclusion of rectal 5-ASA into a combined oral and rectal regimen and maximisation of 5-ASA dose) has clinical and cost benefits that supports wider adoption in clinical practice.
Files in This Item:
T202205260.pdf Download
DOI
10.1136/bmjgast-2021-000853
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191224
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