Combination of corticosteroids with 5-aminosalicylic acids compared to corticosteroids alone for hospitalized patients with active ulcerative colitis

Background: Although 5-amino-salycilic acids (5-ASA) are often used with corticosteroid treatment in moderate-tosevere ulcerative colitis, the value of continuing/initiating 5-ASA in this clinical setting has not been explored. Objectives: To investigate the impact of a combination 5- ASA+corticosteroid therapy on the outcome of hospitalized patients with acute moderate-severe ulcerative colitis. Methods: We conducted a retrospective study of patients hospitalized with moderate-severe ulcerative colitis in two centers, Israel and South Korea. Patients were classified into those who received 5-ASA and corticosteroids and those who received corticosteroids alone. Analysis was performed for each hospitalization event. The primary outcome was the rate of treatment failure defined as the need for salvage therapy (cyclosporin-A/infliximab/colectomy). The secondary outcomes were 30 days re-admission rates, in-hospital mortality rates, time to improvement, and length of hospitalization. Results: We analyzed 209 hospitalization events: 151 patients (72%) received 5-ASA+corticosteroids and 58 (28%) corticosteroids alone. On univariate analysis the combination therapy group had a lower risk for treatment failure (11% vs. 31%, odds ratio 0.28, 95% confidence interval 0.13–0.59, P = 0.001). However, this difference disappeared on multivariate analysis, which showed pre-admission oral corticosteroid treatment to be the most significant factor associated with the need for salvage therapy. Conclusions: A signal for possible benefit of a combination 5-ASA and corticosteroids therapy was found, but was confounded by the impact of pre-admission corticosteroid treatment.