Clinical Background Factors as Predictors of the Efficacy of 5-Aminosalicylic Acid Suppositories in Patients with Ulcerative Colitis

Kazuhiko Uchiyama; Tomohisa Takagi; Katsura Mizushima; Kohei Asaeda; Mariko Kubota-Kajiwara; Takeshi Sugaya; Saori Kashiwagi; Yuki Minagawa; Yuma Hotta; Makoto Tanaka; Ken Inoue; Kazuhiro Katada; Kazuhiro Kamada; Takeshi Ishikawa; Hiroaki Yasuda; Hideyuki Konishi; Mitsuo Kishimoto; Yuji Naito; Yoshito Itoh

doi:10.1159/000533543

Clinical Background Factors as Predictors of the Efficacy of 5-Aminosalicylic Acid Suppositories in Patients with Ulcerative Colitis

Inflamm Intest Dis. 2023 Aug 10;8(2):84-90. doi: 10.1159/000533543. eCollection 2023 Oct.

Authors

Kazuhiko Uchiyama¹, Tomohisa Takagi^{1

2}, Katsura Mizushima³, Kohei Asaeda¹, Mariko Kubota-Kajiwara¹, Takeshi Sugaya⁴, Saori Kashiwagi¹, Yuki Minagawa¹, Yuma Hotta¹, Makoto Tanaka¹, Ken Inoue¹, Kazuhiro Katada¹, Kazuhiro Kamada¹, Takeshi Ishikawa¹, Hiroaki Yasuda¹, Hideyuki Konishi¹, Mitsuo Kishimoto⁵, Yuji Naito³, Yoshito Itoh¹

Affiliations

¹ Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
² Department for Medical Innovation and Translational Medical Science, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
³ Department of Human Immunology and Nutrition Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁴ Medical Regulatory Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁵ Department of Surgical Pathology, Kyoto City Hospital, Kyoto, Japan.

Abstract

Introduction: Although the efficacy of 5-aminosalicylic acid (ASA) suppositories for ulcerative colitis (UC) has been reported in many studies, many studies have also described poor adherence to 5-ASA suppository regimens. We aimed to identify the clinical background factors that influence adherence to 5-ASA suppositories to improve adherence and efficacy of the treatment.

Methods: We conducted a retrospective cohort study of 61 patients with active UC who were using 5-ASA suppositories. All patients underwent endoscopy and rectal biopsy for histological diagnosis prior to 5-ASA suppository treatment. The efficacy of 5-ASA suppository treatment was compared in relation to clinical background factors (sex, age, disease duration, disease type, clinical activity, Ulcerative Colitis Endoscopic Index of Severity, histological activity, serum C-reactive protein level, concomitant use of immunomodulators, history of steroid use, and dose of oral 5-ASA).

Results: The efficacy of 5-ASA suppositories was significantly related to low Lichtiger Colitis Activity Index (LCAI) scores and proctitis type prior to its use. In terms of sex, females tended to show higher efficacy. Multivariate logistic regression analysis using these three factors showed high predictive value for the efficacy of 5-ASA suppositories (AUC, 0.788; sensitivity, 87.2%; and specificity, 63.7%).

Conclusion: This study is the first to extract clinical background factors for predicting the efficacy of 5-ASA suppositories. The use of 5-ASA suppositories in patients who are expected to show efficacy will be effective in improving patient co-operation.

Keywords: 5-ASA suppository; Clinical background; Lichtiger Colitis Activity Index; Ulcerative Colitis Endoscopic Index of Severity; Ulcerative colitis.

Grants and funding

This work was partly supported by a MAFF-commissioned project study on “Project for the realization of foods and dietary habits to extend healthy life expectancy” to Y.N. (No. JPJ009842), a Grant-in-Aid for Scientific Research (KAKENHI) (C) to K.U. (No. 18K06224) from the Japan Society for the Promotion of Science (JSPS), and a Grant-in-Aid for Scientific Research (KAKENHI) (C) to T.T. (No. 20K08292) from the Japan Society for the Promotion of Science (JSPS).