Efficacy of 5-Aminosalicylic Acid Continuation versus Discontinuation in Patients with Ulcerative Colitis Escalated to Advanced Therapy: A Systematic Review and Meta-Analysis of Adjusted Effect Estimates

Background and Aims The benefit of continuing 5-aminosalicylates (5-ASA) in patients with ulcerative colitis (UC) escalated to advanced therapies remains uncertain. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of 5-ASA continuation versus discontinuation in this population. Methods We systematically searched PubMed, Embase, and Cochrane databases for studies comparing 5-ASA continuation versus discontinuation in adult patients with UC escalated to advanced therapies. Adjusted effect estimates were pooled using random-effects models. Results The meta-analysis comprised nine observational cohorts and two studies presenting post hoc analyses from eight clinical trials. We included 11,487 patients, with 9,105 assigned to 5-ASA continuation and 2,382 to 5-ASA discontinuation. Compared to discontinuation, 5-ASA continuation was associated with decreased odds of achieving clinical remission (aOR 0.72; 95% CI 0.52-0.99; I2=0%). There were no significant differences between groups for corticosteroid-free clinical remission (aOR 0.71; 95% CI 0.41-1.23; I2=0%), clinical response (aOR 0.94; 95% CI 0.69-1.28; I2=0%), endoscopic healing (OR 1.00; 95% CI 0.71-1.41; I2=54.6%), and biochemical remission (aOR 1.13; 95% CI 0.76-1.68; I2=31%). In time-to-event analyses, no significant differences were found between groups for UC-related hospitalization (aHR 0.99; 95% CI 0.86-1.13; I2=0%), UC-related surgery (aHR 1.02; 95% CI 0.80-1.29;; I2=13%), new corticosteroid prescription (aHR 0.97; 95% CI 0.88-1.07; I2=0%), composite adverse events (aHR 0.96; 95% CI 0.87-1.06; I2=0%), and loss of response (aHR 0.92; 95% CI 0.75-1.12; p = 0.39; I2=61%). Conclusion In patients with UC escalated to advanced therapies, 5-ASA continuation was associated with decreased odds of achieving clinical remission compared to discontinuation, with no significant differences observed for secondary efficacy or safety endpoints.