A European community-based inception cohort study of unselected Crohn’s disease patients depicted that despite of unclear efficacy of 5-ASA, it yielded satisfactory results during the initial disease course.

Epi-IBD, a prospective population-based inception cohort study was performed in Europe to examine treatment with 5-ASA in patients having Crohn’s disease. This study also examined the disease course of a subgroup of individuals given 5-ASA as maintenance therapy during their initial year of the disease.

Overall, 488 participants were monitored from their diagnosis time. The researchers gathered information on clinical data, disease activity, demographics, medical therapy, rates of surgery, cancers, and mortality of the enrolled participants. The patient management was left to the discretion of the gastroenterologists.

For a median duration of 28 months, 292 (60%) patients with Crohn’s disease were administered with 5-ASA. During the first year after diagnosis, 78 (16%) patients were managed with 5-ASA monotherapy.

A sub-group of these patients witnessed a quiescent disease course without requiring additional treatment during follow-up. A mild disease course was witnessed in individuals who received monotherapy with 5-ASA. Notably, only nine (12%) subjects were found to require surgery, hospitalization, or developed stricturing or penetrating disease. Most individuals never needed more intensive treatment.

The remaining 214 subjects were managed with the help of 5-ASA as the first maintenance drug. However, most subjects eventually escalated to other therapeutics including immunomodulators, biological therapy, and surgery, as depicted in the following table:

5-ASA served as the initial treatment choice as most patients were managed with 5-ASA immediately following diagnosis or after an initial course of steroids and then stepped up to other drugs for maintenance treatment.

During the five years of follow-up, a substantial subgroup of patients received only 5-ASA as a maintenance treatment. This subgroup of patients was found to be older, had less complicated disease behavior at diagnosis, and displayed a mild/quiescent disease course with only very few patients experiencing disease progression or surgery.

Thus, despite the conflict regarding 5-ASA effectiveness in Crohn’s disease patients, its usage seems to offer a satisfying therapy for both patients and clinicians.