No increased risk of flare in ulcerative colitis patients in corticosteroid‐free remission after stopping 5‐aminosalicylic acid: A territory‐wide population‐based study.

Background and Aim: Whether 5‐aminosalicylic acid (ASA) can be stopped in patients with stable ulcerative colitis (UC) remains unclear. We aimed to examine whether 5‐ASA can be safely withdrawn in UC patients who have been in corticosteroid‐free clinical remission for ≥ 1 year. Methods: This is a retrospective cohort study using territory‐wide healthcare database in Hong Kong. Primary outcome was development of UC flare, defined as new corticosteroid use or UC‐related hospitalizations within 5 years. UC patients on oral 5‐ASA ≥ 2 g daily for ≥ 1 year with C‐reactive protein (CRP) < 10 mg/dL and no 5‐ASA dosage escalation, UC‐related hospitalization or corticosteroid use in the past year were included. Patients on biological agents were excluded. Patients were classified as "stopping" if 5‐ASA was withdrawn for ≥ 90 days within follow‐up period. We performed multivariable Cox regression models adjusting for demographics, blood parameters and immunosuppressants used. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was reported comparing stopping and continuous‐use groups. Results: A total of 1408 patients were included with a median follow‐up duration of 41.8 months (interquartile range [IQR]: 17.2–60.0 months). Stopping 5‐ASA was not associated with an increased risk of UC flare (aHR 0.91; 95% CI 0.64–1.31; P = 0.620). A higher CRP levels at the time of stopping 5‐ASA (aHR 1.15; 95% CI: 1.01–1.30; P = 0.037) were associated with increased risk of flare. Conclusion: Stopping 5‐ASA in UC patients in corticosteroid‐free remission for ≥ 1 year was not associated with increased risk of flare. Future prospective trials should evaluate the role of stopping 5‐ASA in stable UC patients. [ABSTRACT FROM AUTHOR]