However, despite these therapeutic advances, there are still some unsolved concerns. Serious and potentially fatal infections can occur due to the use of immunosuppressants and biologics. Primary and secondary loss of responsiveness are also often seen in patients on biologics. Therefore, it is important to properly administer 5-ASA prior to the administration of corticosteroids, immunosuppressants, and biologics at the early stage of the disease. After 17 to 18 weeks, more people had their Crohn’s in remission after taking sulfasalazine compared with people who had been taking placebo. About 45% (45 in every 100 people) who took sulfasalazine had their Crohn’s in remission compared with 29% (29 in every 100 people) who took placebo.

Rectal 5-ASAs are often prescribed in addition to oral therapy for short term management of flares, and can also be used long term to maintain symptom control. Van de Meenberg MM. Does the 5-aminosalicylate concentration correlate with the efficacy of oral 5-aminosalicylate and predict response in patients with inflammatory bowel disease? A Systematic Review. Digestion 2020;101:245–61.Kamm MA, Sandborn WJ, Gassull M, et al. Once-daily, high-concentration MMX mesalamine in active ulcerative colitis. Gastroenterology. 2007;132:66–75. Many brands of 5-ASAs have a special coating around the tablet that allows the medication to be released in the correct part of the bowel. It is important to not crush or chew the tablet as this will damage the coating. Depending on brand the tablet may be best taken with food or on an empty stomach. Granules Naganuma M, Iwao Y, Ogata H, et al. Measurement of colonic mucosal concentrations of 5-aminosalicylic acid is useful for estimating its therapeutic efficacy in distal ulcerative colitis: comparison of orally administered mesalamine and sulfasalazine. Inflamm Bowel Dis. 2001;7:221–5. Sninsky CA, Cort DH, Shanahan F, et al. Oral mesalamine (Asacol) for mildly to moderately active ulcerative colitis. A multicenter study. Ann Intern Med. 1991;115:350–5. signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)

Patients taking a 5-ASA may have blood tests done every 6-12 months to monitor liver and kidney function. How long will I be on a 5-ASA?You should have the flu vaccine every year, and the COVID-19, pneumonia, and human papilloma virus (HPV) vaccines according to the recommended schedule. Please refer to the Vaccinations and IBD information sheetfor further information. All 5-ASAs are excreted into breastmilk but are considered safe for use. Infants should be monitored for any intolerance to this small amount, with vomiting, diarrhoea or allergic reactions rarely reported with some 5-ASAs. What are the possible side effects of a 5-ASA?

Common side effects of 5-ASAs may include headaches, abdominal pain or discomfort, nausea, vomiting, diarrhoea and loss of appetite.Kamm et al. also reported that the clinical response in patients receiving MMX 5-ASA was higher than those receiving placebo, but the efficacy in inducing remission was comparable between patients receiving daily doses of 4.8 g and 2.4 g 5-ASA [ 36]. D’Haens et al. reported that patients receiving a high dose (4.8 g) or a standard dose (2.4 g) of 5-ASA had better outcomes than those receiving a low dose (1.2 g) of 5-ASA, and that the clinical efficacy was comparable between the groups receiving 4.8 g and 2.4 g daily [ 37]. Lichtenstein et al. also showed that the clinical remission rate was comparable between patients receiving daily doses of 4.8 g and 2.4 g of 5-ASA, regardless of the extent and severity of the disease [ 16]. However, this study also indicated that daily doses of 4.8 g rather than 2.4 g of 5-ASA was more effective than the placebo in inducing clinical remission among patients switching directly from other low doses of 5-ASA [ 38].