Colon to Rectum
Clin Gastroenterol Hepatol. 2022;20(12):2868–75.e1
Corticosteroids and mesalamine versus corticosteroids for acute severe ulcerative colitis: A randomized controlled trial
Background and aims: Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis. However, whether the addition/continuation of mesalamine with corticosteroids during hospitalization is superior to corticosteroids alone is unknown.
Methods: This was a randomized controlled, investigator-blinded, clinical trial conducted in 10 centers in 7 countries. Patients hospitalized with acute severe ulcerative colitis (Lichtiger score ≥ 10) were eligible. Patients received corticosteroids alone or corticosteroids + mesalamine (4 g/day mesalamine) by a stratified randomization according to mesalamine use before admission. The primary outcome was the percentage of patients who responded to treatment by day 7, defined by a drop > 3 points in the Lichtiger score and an absolute score < 10 without the need for rescue medications or colectomy.
Results: 346 patients were screened, and 149 were included (70/149 female; median age, 41 years). Of these, 73 received corticosteroids + mesalamine, and 76 received corticosteroids alone. For the primary outcome, 53 of 73 patients (72.6%) receiving corticosteroids with mesalamine responded versus 58 of 76 patients (76.3%) on corticosteroids alone (odds ratio = 0.82; 95% confidence interval: 0.39–1.72; p = 0.60). There was no difference between groups in duration of hospitalization, C-reactive protein normalization rate, or colectomy rate up to day 90. The need for biologics among patients receiving combination of corticosteroids with mesalamine was numerically lower by day 30 (p = 0.11) and day 90 (p = 0.07).
Conclusions: In this randomized controlled trial, combination of mesalamine with corticosteroids did not benefit hospitalized patients with acute severe ulcerative colitis more than corticosteroids alone. An exploratory signal for a reduced need for biologics at 90 days in the mesalamine group merits further evaluation.