Risk factors and management strategies associated with non-response to aminosalicylates as a maintenance treatment in ulcerative colitis

Aminosalicylates (5-ASA) are used as the first-line maintenance treatment in patients with mild-moderate ulcerative colitis (UC). Early identification of patients at high risk for 5-ASA non-response and appropriate therapeutic escalation are essential to avoid disease progression. However, the absence of a standardized definition for treatment success makes this a challenging task. The focus of the current review was to describe the risk factors and management strategies associated with 5-ASA non-response. Rates of 5-ASA failure can vary from 17 % to 75 % according to different success definitions, of which clinical relapse is the most prevalent and studied condition. Younger age and endoscopic activity at diagnosis, extensive colitis, early need for corticosteroids, elevated inflammatory markers and non-adherence are consistent risk factors of 5-ASA failure. Given the effectiveness, safety profile and tolerability of this medication, therapy optimization is critical before treatment escalation. Combined use of systemic and topical therapy at an appropriate dose in a once-daily administration and control of adherence could improve success rates.

Automated summary

Aminosalicylates (5-ASA) are commonly used as first-line maintenance treatment for mild-moderate ulcerative colitis (UC). Identifying high-risk patients for 5-ASA non-response early on and optimizing therapy before escalation is essential for preventing disease progression. Risk factors for 5-ASA failure include younger age, endoscopic activity at diagnosis, extensive colitis, early need for corticosteroids, elevated inflammatory markers, and non-adherence. Therapeutic strategies combining systemic and topical therapy, appropriate dosing, once-daily administration, and improved adherence may enhance treatment success rates.