RECTAL AMINOSALICYLATE THERAPY FOR DISTAL ULCERATIVE-COLITIS - A METAANALYSIS

Background: To summarize and quantify the evidence supporting rectal 5 - or 4-aminosalicylate (ASA) therapies for disease exacerbation or rem ission maintenance in distal ulcerative colitis, we performed a meta-a nalysis. Methods: All randomized, double-blind controled trials involv ing aminosalicylate therapy were retrieved from a MEDLINE search, revi ew articles on ulcerative colitis therapy or their bibliographies. Of 55 studies retrieved, 19 met the inclusion criteria, Appraisal and dat a extraction were performed by two observers and scoring disagreements were resolved by consensus. Results: Eleven trials tested 5-ASA and t hree tested 4-ASA in active ulcerative colitis. 5-ASA was superior to placebo for inducing remission or symptomatic improvement in active ul cerative colitis with a pooled odds ratio of 7.36 (95% Confidence inte rval (CI): 4.72-11.47). In four trials the pooled odds ratio for endos copic improvement was 10.04 (95% CI: 5.72-17.61) and for histological improvement 10.31 (95% CI: 5.85-18.18). Studies evaluating 4-ASA sugge st a benefit similar to prednisolone in treating active disease. Five trials assessed remission maintenance with 5-ASA, and when compared to placebo gave a pooled odds ratio of 16.22 (95% CI: 4.71-55.92). No do se-response relationship was observed. ASA compounds were not therapeu tically superior to other treatments. Conclusions: We conclude that re ctal 5-ASA is effective therapy for active distal ulcerative colitis. More trials are needed to assess 4-ASA, dose-response effects and the ideal regimen for remission maintenance.