Atay A, Ergul M, Ozturk O, Acun KC, Cagir Y, Durak MB, Yuksel I. Outcomes of 5-aminosalicylates withdrawal due to non-adherence in ulcerative colitis patients: A step toward evaluating intermittent therapy. World J Gastroenterol 2025; 31(30): 110112 [DOI: 10.3748/wjg.v31.i30.110112]
Corresponding Author of This Article
Ilhami Yuksel, MD, Professor, Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, İhsan Dogramaci Cad. Bilkent, Ankara 06800, Türkiye. yukselilhami@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 14, 2025; 31(30): 110112 Published online Aug 14, 2025. doi: 10.3748/wjg.v31.i30.110112
Outcomes of 5-aminosalicylates withdrawal due to non-adherence in ulcerative colitis patients: A step toward evaluating intermittent therapy
Ali Atay, Mucahit Ergul, Oguz Ozturk, Kadir C Acun, Yavuz Cagir, Muhammed B Durak, Ilhami Yuksel
Ali Atay, Mucahit Ergul, Oguz Ozturk, Kadir C Acun, Ilhami Yuksel, Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Yavuz Cagir, Department of Gastroenterology, Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara 06105, Türkiye
Muhammed B Durak, Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara 063200, Türkiye
Ilhami Yuksel, Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara 06800, Türkiye
Author contributions: Atay A and Yuksel I conceptualized, planned the design of the study, performed data analysis, interpreted the data, and drafted the manuscript; Atay A, Ergul M, Ozturk O, Acun KC, Cagir Y, Durak MB, and Yuksel I performed the data collection; All authors revised and approved the final version of the submitted manuscript to be submitted.
Institutional review board statement: This study was approved by the Ethics Committee of the Ankara Bilkent City Hospital (No. TABED 1-25-1090) and was conducted according to the Declaration of Helsinki.
Informed consent statement: Due to the retrospective nature of the study and use of de-identified data, informed consent was not obtained. This approach was reviewed and approved by the institutional ethics committee.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at (yukselilhami@hotmail.com). Due to the retrospective nature of the study and use of de-identified data, informed consent was not obtained. This approach was reviewed and approved by the institutional ethics committee.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ilhami Yuksel, MD, Professor, Department of Gastroenterology, Faculty of Medicine, Ankara Yildirim Beyazit University, İhsan Dogramaci Cad. Bilkent, Ankara 06800, Türkiye. yukselilhami@hotmail.com
Received: May 30, 2025 Revised: June 14, 2025 Accepted: July 18, 2025 Published online: August 14, 2025 Processing time: 69 Days and 15.9 Hours
Abstract
BACKGROUND
5-aminosalicylates (5-ASA) are the primary treatment for mild to moderate ulcerative colitis (UC). Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.
AIM
To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.
METHODS
Adult patients with UC who were followed up between July 2019 and April 2025 were screened. Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.
RESULTS
Among 880 patients with UC, 30 (3.4%) had 5-ASA withdrawal due to non-adherence while in remission on monotherapy. Twelve patients (40%) had disease relapse after a median of 20 months. The rate of patients in remission was 89% in the first year, decreasing to 73% in the second year, and to 64% in the third year. There were no significant differences between patients with and without relapse in terms of demographics, disease extent, remission duration before 5-ASA withdrawal, previous medications, steroid dependence, 5-ASA formulation, baseline inflammatory markers, or partial and endoscopic Mayo scores. Most patients (75%) who experienced relapse were successfully treated with 5-ASA monotherapy, while one-fourth of them required corticosteroids. No patients required biologic agents, hospitalization, or surgical intervention.
CONCLUSION
Intermittent therapy may be safe and feasible for UC patients, especially those in long-term remission, with treatment interruption up to one year considered acceptable.
Core Tip: In this study, 5-aminosalicylate (5-ASA) withdrawal was observed in 3.4% of patients with ulcerative colitis (UC). Almost half of them developed a relapse. The majority of patients who experienced relapse were treated with 5-ASA monotherapy, while one-fourth of them required corticosteroids. No patients required biological agents, hospitalization, or surgery. Based on our long-term real-world data, intermittent therapy may represent a potentially safe and feasible strategy in terms of relapse risk in patients with UC. Notably, in patients who have sustained long-term clinical remission, a treatment interruption of up to one year may be considered safe.
