BACKGROUND: The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. AIMS: The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. METHODS: In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. RESULTS: Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). CONCLUSION: In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.

1st Department of Medicine Semmelweis University Budapest Hungary

Clinic of Gastroenterology University of Medicine 'Victor Babes' Timisoara Romania

Department of Biomedicine Porto University Porto Portugal

Department of Gastroenterology 53176Herlev Hospital University of Copenhagen Denmark

Department of Gastroenterology and Alimentary Tract Surgery Tampere University Hospital Tampere Finland

Department of Gastroenterology and Liver Diseases 26732Ben Gurion University of the Negev Beer Sheva Israel

Department of Gastroenterology Azienda USL Toscana Centro Florence Italy

Department of Gastroenterology Centro Hospitalar de São João EPE Porto Portugal

Department of Gastroenterology Complexo Hospitalario Universitario de Vigo Vigo Spain

Department of Gastroenterology Hepatology and Nutrition 162072University Hospital Centre Zagreb Zagreb Croatia

Department of Gastroenterology Lithuanian University of Health Sciences Kaunas Lithuania

Department of Gastroenterology Moscow Regional Research Clinical Institute Moscow Russian Federation

Department of Gastroenterology North Zealand University Hospital Frederikssund Denmark

Department of Gastroenterology Örebro University Örebro Sweden

Department of Gastroenterology State University of Medicine and Pharmacy of the Republic of Moldova Chisinau Republic of Moldova

Department of Hepatology and Gastroenterology Aarhus University Hospital Aarhus Denmark

Department of Internal Medicine 26732Ben Gurion University of the Negev Beer Sheva Israel

Department of Internal Medicine Csolnoky Ferenc Regional Hospital Veszprem Hungary

Department of Medicine Herning Central Hospital Herning Denmark

Department of Surgical Oncological and Gastroenterological Sciences University of Padua Padova Italy

Digestive Diseases Research Group Galicia Sur Health Research Institute Vigo Spain

Division of Gastroenterology 223089Mater Dei Hospital Msida Malta

Division of Gastroenterology McGill University Health Center Montreal Canada

Division of Gastroenterology University Hospital and University of Ioannina Greece

Division of Gastroenterology University of Tarty Tartu Estonia

Faculty of Medicine and Health Technology Tampere University Tampere Finland

Gastroenterology Department Odense University Hospital Odense Denmark

Gastroenterology Department Slagelse Hospital Slagelse Denmark

Gastroenterology Unit 26993Amiens University Hospital Amiens France

Hull University Teaching Hospitals NHS Trust Hull UK

Hull York Medical School Hull UK

IBD Clinical and Research Centre ISCARE Prague Czech Republic

IBD Department Imperial College London London UK

Institute for Digestive Research Lithuanian University of Health Sciences Kaunas Lithuania

Institute for Translational Research in Inflammation Lille University Lille France

Institute of Molecular Medicine University of Southern Denmark Odense Denmark

Institute of Pharmacology Charles University Prague Prague Czech Republic

IRS Center Soenderjylland University Hospital of Southern Denmark Aabenraa Denmark

Medical Department The National Hospital of the Faroe Islands Torshavn Faroe Islands

Private practice Nicosia Cyprus

Public Health Epidemiology and Economic Health Lille University and Hospital Lille France

School of Medicine University of Zagreb Zagreb Croatia

UO Gastroenterologia ed Endoscopia digestiva Hospital Morgagni Pierantoni Forlì Italy

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