Strong evidence indicates that mesalamine, sulfasalazine, and other 5-aminosalicylic drugs effectively induce remission in mild-to-moderately active ulcerative colitis (UC) and prevent relapse in quiescent UC.

However, these agents are unlikely to induce remission in active Crohn’s disease (CD), and there is insufficient evidence to recommend them for the prevention of relapse in quiescent CD.

This is just one set of conclusions presented in a new clinical monograph from the American College of Gastroenterology (ACG). An ACG task force undertook the systematic review of trials that evaluated medical therapies of active and quiescent of UC and CD, the two components of inflammatory bowel disease (IBD). The committee developed evidence-based statements and graded the strength of each recommendation.

The evidence garnered strong recommendations from the task force in the use of corticosteroid therapies for inducing remission in active UC and in the use of budesonide for inducing remission in mild-to-moderately-active CD, although the quality of evidence for these recommendations was deemed low. Budesonide was not recommended for preventing relapse in quiescent CD.

The ACG also makes recommendations for or against the use of immunosuppressant therapies in UC and CD. For example, the monograph offers the “weak” recommendations that the thio­purine analogs 6-MP and its pro-drug azathioprine are not recommended for inducing remission in active UC or active CD. The quality of evidence on the UC recommendation is graded as “very low”; for the CD recommendation, “low.”

Recommendations on the use of biologic and antibiotic therapies are also addressed.

The authors note that the optimum maintenance therapy in UC and CD remains to be determined. Even so, they write, “This monograph highlights the wealth of data that can guide the clinician in the medical management of IBD.”

Tally NJ et al. Am J Gastroenterol. 2011;106:S2-S25