5-aminosalicylate maintenance is not superior to no maintenance in patients with newly diagnosed Crohn's disease—A nationwide cohort study

Ohad Atia, Idan Goren*, Tali Sharar Fischler, Yisca Loewenberg Weisband, Shira Greenfeld, Revital Kariv, Natan Ledderman, Eran Matz, Ramit Magen Rimon, Iris Dotan, Dan Turner, Henit Yanai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: 5-aminosalicylates (5-ASA) are widely used in Crohn's disease (CD) despite guidelines advising otherwise. We aimed to assess in nationwide study the outcomes of first-line 5-ASA maintenance therapy (5-ASA-MT) compared with no maintenance treatment (no-MT) in patients with newly diagnosed CD. Methods: We utilised data from the epi-IIRN cohort, including all patients with CD diagnosed in Israel between 2005 and 2020. Propensity score (PS) matching was utilised to compare outcomes in the 5-ASA-MT versus no-MT groups. Results: Of the 19,264 patients diagnosed with CD, 8610 (45%) fulfilled the eligibility criteria (3027 [16%] received 5-ASA-MT and 5583 [29%] received no-MT). Both strategies declined over the years; 5-ASA-MT from 21% of CD patients diagnosed in 2005 to 11% in 2019 (p < 0.001) and no-MT from 36% to 23% (p < 0.001). The probability of maintaining therapy at 1, 3 and 5 years from diagnosis: 5-ASA-MT—78%, 57% and 47% and no-MT—76%, 49% and 38% respectively (p < 0.001). PS analysis successfully matched 1993 pairs of treated and untreated patients and demonstrated comparable outcomes of time to: biologic (p = 0.2), steroid dependency (p = 0.9), hospitalisation (p = 0.5) and CD-related surgery (p = 0.1). Rates of acute kidney injury (5.2% vs. 3.3%; p < 0.001) and pancreatitis (2.4% vs. 1.8%; p = 0.03) were higher in the 5-ASA-MT group compared with the no-MT group but after PS matching the rates of adverse events were similar. Conclusion: First-line 5-ASA monotherapy was not superior to no-MT but associated with a slightly higher rates of adverse events, while both strategies have declined over the years. These findings suggest that a subset of patients with mild CD may be offered a watchful waiting approach.

Original languageAmerican English
Pages (from-to)1004-1013
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Issue number9
StatePublished - May 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.


  • 5-aminosalicylic acid
  • Crohn’s disease
  • epi-IIRN
  • nationwide cohort
  • newly diagnosed
  • outcomes


Dive into the research topics of '5-aminosalicylate maintenance is not superior to no maintenance in patients with newly diagnosed Crohn's disease—A nationwide cohort study'. Together they form a unique fingerprint.

Cite this