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

• Published in: BMJ open gastroenterology Vol. 9; no. 1; p. e000853
• Main Authors: Louis, Edouard, Paridaens, Kristine, Al Awadhi, Sameer, Begun, Jakob, Cheon, Jae Hee, Dignass, Axel U, Magro, Fernando, Márquez, Juan Ricardo, Moschen, Alexander R, Narula, Neeraj, Rydzewska, Grazyna, Freddi, Matthew J, Travis, Simon PL
• Format: Journal Article Web Resource
• Language: English
• Published: England BMJ Publishing Group Ltd 01.02.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: 3XC8GUZ6CB (Sulfasalazine); 4Q81I59GXC (Mesalamine); 5-aminosalicylic acid (5-asa); Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use; Biological Products; Biological Products - therapeutic use; Colitis, Ulcerative - chemically induced; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative/chemically induced/drug therapy; Decision trees; Gastroenterology & hepatology; Gastroentérologie & hépatologie; Human health sciences; Humans; Inflammatory Bowel Disease; Mesalamine - adverse effects; Mesalamine - therapeutic use; Mesalamine/adverse effects/therapeutic use; Neoplasm Recurrence, Local - chemically induced; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local/chemically induced/drug therapy; Patients; Remission (Medicine); Remission Induction; Sciences de la santé humaine; Steroids; Sulfasalazine - adverse effects; Tumor necrosis factor-TNF; ulcerative colitis; 5-aminosalicylic acid (5-asa); ulcerative colitis; inflammatory bowel disease
• ISSN: 2054-4774; 2054-4774
• DOI: 10.1136/bmjgast-2021-000853

Objectives5-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.MethodsA 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).ResultsDuring 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.ConclusionModelling 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.