Evidence map›Paper›PMID 34797442›Full record

ArticleDigestive diseases and sciences2022

No Benefit of Continuing 5-Aminosalicylates in Patients with Crohn's Disease Treated with Anti-metabolite Therapy.

Dominic Picetti, Jihoon Kim, Wenhong Zhu, William J Sandborn, Vipul Jairath, Siddharth Singh

Open access · greenAbstract read
In one paragraph

Article in Digestive diseases and sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.3field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Dominic PicettiDivision of Biomedical Informatics, University of California San Diego, 9452 Medical Center Dr, ACTRI 1W501, La Jolla, San Diego, CA, 92093, USA.
Jihoon KimVisting Fellow, OptumLabs, Eden Prairie, MN, USA.
Wenhong ZhuAltman Clinical and Translational Research Institute, University of California San Diego, La Jolla, San Diego, CA, USA.
William J SandbornDivision of Biomedical Informatics, University of California San Diego, 9452 Medical Center Dr, ACTRI 1W501, La Jolla, San Diego, CA, 92093, USA.
Vipul JairathRobarts Clinical Trials, Inc. London, London, ON, Canada.
Siddharth SinghDivision of Biomedical Informatics, University of California San Diego, 9452 Medical Center Dr, ACTRI 1W501, La Jolla, San Diego, CA, 92093, USA. sis040@ucsd.edu.ORCID 0000-0002-2640-7269
University of California San Diego · USWestern University · CA

Funding

UC San Diego Clinical and Translational Research InstituteUL1TR001442 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI FIRESTEIN, GARY S, HOGARTH, MICHAEL · 2015 to 2024
$88.3M
Comparative Risks and Benefits of Pharmacological Therapies for Older Patients with Inflammatory Bowel DiseasesK23DK117058 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI SINGH, SIDDHARTH · 2018 to 2022
$971k
Predicting Short- and Long-term Risk of Serious Infections in Older Patients with Inflammatory Bowel DiseasesR03DK129631 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI SINGH, SIDDHARTH · 2021 to 2022
$203k
NCATS NIH HHS UL1 TR001442NIDDK NIH HHS K23 DK117058NIDDK NIH HHS R03 DK129631
6 · The paper itself

Abstract

BACKGROUND AND

aims5-aminosalicylates (5-ASA) are frequently used in the management of Crohn's disease (CD). We used a de-identified administrative claims database to compare patterns and outcomes of continuing versus stopping 5-ASA in patients with CD who escalated to anti-metabolite monotherapy.

methodsPatients with CD on 5-ASA who were new users of anti-metabolite monotherapy and followed for at least 12 months from OptumLabs® Data Warehouse. Three patterns of 5-ASA use were identified: stopped 5-ASA, short-term 5-ASA (use for < 6 months after starting anti-metabolites), or persistent 5-ASA (use for > 6 months after starting anti-metabolites). Outcomes (need for corticosteroids, risk of CD-related hospitalization and/or surgery, treatment escalation to biologic therapy) were compared using Cox proportional hazard analysis adjusting for key covariates, with a 12-month immortal time period.

resultsOf 3036 patients with CD who were new-users of anti-metabolite monotherapy, 667 (21.9%), 626 (20.6%), and 1743 (57.4%) stopped 5-ASA, used 5-ASA transiently or persistently, respectively. Compared to patients who stopped 5-ASA after starting anti-metabolites, persistent 5-ASA use was associated with a higher risk of corticosteroid use (HR, 1.24 [1.08-1.42]), without an increase in risk of CD-related hospitalization (HR, 1.21 [0.98-1.49]), CD-related surgery (HR, 1.28 [0.90-1.80]) or treatment escalation (HR, 0.85 [0.62-1.20]). Sensitivity analyses using a 3-month window after initiation of anti-metabolites to classify patients as continuing vs. stopping 5-ASA showed similar results. Residual confounding by disease severity could not be excluded.

conclusion5-ASAs are frequently continued long-term even after escalation to anti-metabolite therapy in patients with CD but offer no clinical benefit over stopping 5-ASA.

Indexed as

Crohn DiseaseMesalamineAdrenal Cortex HormonesAnti-Inflammatory Agents, Non-SteroidalBiological TherapyHumansAdrenal Cortex HormonesAnti-Inflammatory Agents, Non-SteroidalMesalamineImmunosuppressiveInflammatory bowel diseasesLow-value careMesalamine

Identifiers

PMID34797442
PMCPMC9117569
OpenAlexW3213776372

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.