The risk factor of clinical relapse in ulcerative colitis patients with low dose 5-aminosalicylic acid as maintenance therapy: A report from the IBD registry

Background 5-Aminosalicylic acids (5-ASA) are effective for ulcerative colitis (UC) as a maintenance therapy. It is not clear when and how to reduce a dose of 5-ASA after inducing remission. We aimed to investigate the clinical characteristics and evaluate the risk factors of relapse for UC patients receiving 5-ASA. Methods The medical records of prospectively registered UC patients who received oral 5-ASA as maintenance therapy between January and December 31, 2014, were investigated. The patients' clinical characteristics in a 2-year follow-up were compared between a relapse group and a remission group. Results Of 527 UC patients receiving only oral 5-ASA, 390 (74.0%) maintained remission and 137 (26.0%) relapsed during the follow-up period. Multivariable analysis indicated that a shorter duration of disease remission (p < 0.001, OR: 1.24, 95% Cl: 1.12-1.38) was statistically significant for each comparison between the remission and relapse groups among all the patients. Risk factors for clinical relapse were a shorter duration of disease remission (p < 0.001, OR: 1.17, 95% C: 1.04-1.33) in the high-dose 5-ASA group and a shorter duration of disease remission (p=0.003, OR: 1.45, 95% C: 1.13-1.89) and a history of steroid use (p= 0.048, OR: 4.73, 95% C: 1.01-22.2) in the low-dose group. Conclusions A dose reduction of 5-ASA might be cautiously selected in UC patients with a history of steroid use and a shorter duration of disease remission.