5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis.
BACKGROUND/AIMS
5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota.


METHODS
We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC.


RESULTS
Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05).


CONCLUSIONS
In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.
['Mizuno|Shinta|S|', 'Ono|Keiko|K|', 'Mikami|Yohei|Y|', 'Naganuma|Makoto|M|', 'Fukuda|Tomohiro|T|', 'Minami|Kazuhiro|K|', 'Masaoka|Tatsuhiro|T|', 'Terada|Soichiro|S|', 'Yoshida|Takeshi|T|', 'Saigusa|Keiichiro|K|', 'Hirahara|Norimichi|N|', 'Miyata|Hiroaki|H|', 'Suda|Wataru|W|', 'Hattori|Masahira|M|', 'Kanai|Takanori|T|']
5-Aminosalicylic acid Dysbiosis Prognosis Colitis, ulcerative