Combination Of Corticosteroids And 5-Aminosalycilates Or Corticosteroids Alone For Patients With Moderate-Severe Active Ulcerative Colitis: A Global Survey Of Physicians' Practice

Background: There are sparse data on whether 5-aminosalicylates (5ASA) confer additional benefit when combined with corticosteroids (CS) in active ulcerative colitis (UC). We examined gastroenterologists' approach toward this management decision Methods: A cross-sectional questionnaire exploring physicians' attitude toward 5ASA+CS combination therapy versus CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents' agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses Results: 664 questionnaires were distributed and 349 received (52.6% response rate). Of these, 340 were eligible respondents from 12 countries (Figure 1). In total, 221 (65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108 (32%) would stop the 5ASA (p<0.001), and 11 (3%) are undecided (Figure 2). Similarly, 62% would continue 5ASA in an out-patient starting oral CS. However, only 140/340 (41%) would proactively start 5ASA in a hospitalized patient not receiving 5ASA before admission. Most (97%) physicians consider the safety profile of 5ASA as very good. Only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. On multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA+CS were positively associated with the decision to continue 5ASA with CS. Figure 1. Distribution of countries of practice among the responding physicians. Figure 2. Continue 5ASA in a hospitalized steroid-treated patient. Conclusions: Despite the absence of supporting evidence, the majority of gastroenterologists endorse combination of 5ASA + corticosteroids for patients with active moderate-to-severe UC, although practices vary greatly among clinicians. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.