| Title: |
Modelling the benefits of an optimised treatment strategy for 5-ASA in mild-to-moderate ulcerative colitis. |
| Authors: |
Louis, E; Paridaens, K; Al Awadhi, S; Begun, J; Cheon, JH; Dignass, AU; Magro, F; Márquez, JR; Moschen, AR; Narula, N; Rydzewska, G; Freddi, MJ; Travis, SP |
| Publisher Information: |
BMJ Publishing Group |
| Publication Year: |
2023 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Objectives 5-aminosalicylate (mesalazine; 5-ASA) is an established first-line treatment for mild-to-moderate ulcerative colitis (UC). This study aimed to model the benefits of optimising 5-ASA therapy. Methods A decision tree model followed 10 000 newly diagnosed patients with mild-to-moderately active UC through induction and 1 year of maintenance treatment. Optimised treatment (maximising dose of 5-ASA and use of combined oral and rectal therapy before treatment escalation) was compared with standard treatment (standard doses of 5-ASA without optimisation). Modelled data were derived from published meta-analyses. The primary outcomes were patient numbers achieving and maintaining remission, with an analysis of treatment costs for each strategy conducted as a secondary outcome (using UK reference costs). Results During induction, there was a 39% increase in patients achieving remission through the optimised pathway without requiring systemic steroids and/or biologics (6565 vs 4725 for standard). Potential steroidal/biological adverse events avoided included: seven venous thromboembolisms and eight serious infections. Out of the 6565 patients entering maintenance following successful induction on 5-ASA, there was a 21% reduction in relapses when optimised (1830 vs 2311 for standard). This translated into 297 patients avoiding further systemic steroids and 214 biologics. Optimisation led to an average net saving of £272 per patient entering the model for the induction and maintenance of remission over 1 year. Conclusion Modelling suggests that optimising 5-ASA therapy (both the inclusion of rectal 5-ASA into a combined oral and rectal regimen and maximisation of 5-ASA dose) has clinical and cost benefits that supports wider adoption in clinical practice. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1136/bmjgast-2021-000853 |
| Availability: |
https://doi.org/10.1136/bmjgast-2021-000853; https://ora.ox.ac.uk/objects/uuid:8dd6cebe-53ac-4b5b-91cf-ae764f5427a1 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution-NonCommercial (CC BY-NC) |
| Accession Number: |
edsbas.73AE119F |
| Database: |
BASE |