[en] OBJECTIVES: 5-aminosalicylate (mesalazine; 5-ASA) is an established first-line treatment for mild-to-moderate ulcerative colitis (UC). This study aimed to model the benefits of optimising 5-ASA therapy. METHODS: A decision tree model followed 10 000 newly diagnosed patients with mild-to-moderately active UC through induction and 1 year of maintenance treatment. Optimised treatment (maximising dose of 5-ASA and use of combined oral and rectal therapy before treatment escalation) was compared with standard treatment (standard doses of 5-ASA without optimisation). Modelled data were derived from published meta-analyses. The primary outcomes were patient numbers achieving and maintaining remission, with an analysis of treatment costs for each strategy conducted as a secondary outcome (using UK reference costs). RESULTS: During induction, there was a 39% increase in patients achieving remission through the optimised pathway without requiring systemic steroids and/or biologics (6565 vs 4725 for standard). Potential steroidal/biological adverse events avoided included: seven venous thromboembolisms and eight serious infections. Out of the 6565 patients entering maintenance following successful induction on 5-ASA, there was a 21% reduction in relapses when optimised (1830 vs 2311 for standard). This translated into 297 patients avoiding further systemic steroids and 214 biologics. Optimisation led to an average net saving of £272 per patient entering the model for the induction and maintenance of remission over 1 year. CONCLUSION: Modelling suggests that optimising 5-ASA therapy (both the inclusion of rectal 5-ASA into a combined oral and rectal regimen and maximisation of 5-ASA dose) has clinical and cost benefits that supports wider adoption in clinical practice.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Louis, Edouard ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gastroentérologie, hépatologie, onco. digestive ; Hepato-Gastroenterology and Digestive Oncology Department, University and Centre
Paridaens, Kristine; Ferring International Center SA, Saint-Prex, Switzerland
Al Awadhi, Sameer; Gastroenterology Department, Rashid Hospital, Dubai, UAE.
Begun, Jakob; Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, Queensland,
Cheon, Jae Hee; Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Dignass, Axel U; Department of Medicine I, Agaplesion Markus Hospital, Goethe-University,
Magro, Fernando; Department of Biomedicine, Unit of Pharmacology and Therapeutics, University of ; Department of Gastroenterology, São João University Hospital, Porto, Portugal.
Márquez, Juan Ricardo; Colorectal Surgery Department, Instituto de Coloproctologia ICO Clinica Las
Moschen, Alexander R; University Clinic for Internal Medicine, Johannes Kepler University, Linz,
Narula, Neeraj; Division of Gastroenterology, Department of Medicine and Farncombe Family
Rydzewska, Grazyna; Clinical Department of Internal Medicine and Gastroenterology with Inflammatory ; Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland.
Freddi, Matthew J ; Violicom Medical Limited, Aldermaston, UK.
Travis, Simon Pl; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS
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