Intest Res.  2021 Apr;19(2):225-231. 10.5217/ir.2020.00023.

Effect of acid-reducing agents on clinical relapse in ulcerative colitis with pH-dependent-released 5-aminosalicylic acid: a multicenter retrospective study in Japan

• Shimodaira Y
• Onochi K
• Watanabe K
• Takahashi S
• Fukuda S
• Watanabe N
• Koizumi S
• Matsuhashi T
• Iijima K

• KMID: 2515481
• DOI: http://doi.org/10.5217/ir.2020.00023

Abstract

Background/Aims
5-Aminosalicylic acid (5-ASA) is a basic drug for inducing and maintaining remission for ulcerative colitis. One of its formulations has a coating with a pH-dependent degradation that ensures the release 5-ASA at the terminal ileum. No evidence has been shown concerning the effects of proton pump inhibitors (PPIs) or H₂ receptor antagonists (H2RAs) on the clinical course of ulcerative colitis patients in remission. The present study assessed the effect of PPIs or H2RAs on the relapse of ulcerative colitis patients in clinical remission maintained by pH-dependent released 5-ASA.
Methods
Ulcerative colitis patients who had been prescribed time- or pH-dependent-released 5-ASA between January 2015 and December 2018 were enrolled in this multicenter retrospective study. The period of remission until relapse occurred was analyzed among the patients taking time-dependent-released 5-ASA or pH-dependent-released 5-ASA with/without PPIs or H2RAs.
Results
One hundred and nineteen patients were analyzed in this study. In the primary endpoint, the relapse rate was higher in patients taking pH-dependent-released 5-ASA and PPIs or H2RAs than in those taking the pH-dependent-released 5-ASA without PPIs or H2RAs, while the relapse rate was similar in patients taking the time-dependent-released 5-ASA with or without PPIs or H2RAs concomitantly. Patients with a short duration of disease and middle-aged patients more frequently showed relapse with PPIs or H2RAs than the other patients.
Conclusions
The coadministration of PPIs or H2RAs affects the clinical course of ulcerative colitis in remission maintained by pH-dependent-released 5-ASA.

Keyword

5-Aminosalicylic acid; Proton pump inhibitors; H receptor antagonists

Figure

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  Fig. 1. Flowchart of the study. UC, ulcerative colitis.

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  Fig. 2. Kaplan-Meier curves demonstrating the relapse-free rate in ulcerative colitis. Hashed lines indicate censored cases. (A) Patients prescribed Pentasa (thick line) and Pentasa with PPIs or H2RAs (solid line). (B) Patients prescribed Asacol (thick line) and Asacol with PPIs or H2RAs (solid line). PPIs, proton pump inhibitors; H2RAs, H2 receptor antagonists.

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  Fig. 3. Kaplan-Meier curves demonstrating the relapse-free rate in ulcerative colitis. Hashed lines indicate censored cases. Patients prescribed Asacol (thick line) and Asacol with PPIs or H2RAs (solid line). Patients 15–49 years of age (A) and 50–65 years of age (B) were shown. Patients prescribed Asacol (thick line) and Asacol with PPIs or H2RAs (solid line). Patients of 10 or fewer years’ disease duration (C) and more than 10 years’ disease duration (D) were shown. PPIs, proton pump inhibitors; H2RAs, H2 receptor antagonists.

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