MESALAMINE IN THE MAINTENANCE TREATMENT OF CROHNS-DISEASE - A METAANALYSIS ADJUSTED FOR CONFOUNDING VARIABLES

Background & Aims: The benefit of mesalamine for maintenance of remiss ion in Crohn's disease is controversial. The aim of this study was to assess the effectiveness of mesalamine in maintaining remission of qui escent Crohn's disease, Methods: Pertinent randomized clinical trials were selected using MEDLINE (1986-1997) database, reference lists from published articles or reviews. Fifteen randomized, controlled trials of mesalamine maintenance therapy involving a total of 2097 patients w ere selected, The crude rates of patients with symptomatic relapse in treated and control groups were extracted according to the intention-t o-treat method. Results: Therapy with mesalamine significantly reduced the risk of symptomatic relapse (pooled risk difference, -6.3%; 95% c onfidence interval, -10.4% to -2.1%). The pooled risk difference was s ignificant in the postsurgical setting (-13.1%; 95% confidence interva l, -21.8% to -4.5%) but not in the medical setting (-4.7%; 95% confide nce interval, -9.6% to 2.8%), Multivariate model predicts that the pro bability of symptomatic relapse significantly decreases with mesalamin e treatment, by increasing proportion of patients with ileal disease, with prolonged disease duration, and with surgically induced remission , Conclusions: Mesalamine may be recommended for maintaining remission of quiescent Crohn's disease. The benefit is mainly observed in the p ostsurgical setting, in patients with ileitis and with prolonged disea se duration.