5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis

• Published in: Intestinal research Vol. 18; no. 1; pp. 69 - 78
• Main Authors: Mizuno, Shinta, Ono, Keiko, Mikami, Yohei, Naganuma, Makoto, Fukuda, Tomohiro, Minami, Kazuhiro, Masaoka, Tatsuhiro, Terada, Soichiro, Yoshida, Takeshi, Saigusa, Keiichiro, Hirahara, Norimichi, Miyata, Hiroaki, Suda, Wataru, Hattori, Masahira, Kanai, Takanori
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of Intestinal Diseases 01.01.2020; 대한장연구학회
• Subjects: 5-aminosalicylic acid; colitis, ulcerative; dysbiosis; Original; prognosis; 내과학; 5-Aminosalicylic acid; Prognosis; Dysbiosis; Colitis, ulcerative
• ISSN: 1598-9100; 2288-1956
• DOI: 10.5217/ir.2019.00084

5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05). In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.