Which medications in the drug class 5-Aminosalicylic Acid Derivatives are used in the treatment of Crohn Disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

5-Aminosalicylic Acid Derivatives

The 5-ASA derivative agents are used to treat mild-to-moderate Crohn disease and to maintain remission.

Mesalamine rectal (Canasa, Rowasa)

Rectal mesalamine is a formulation of mesalamine that specifically releases 5-ASA in the distal colon. This agent elicits an anti-inflammatory effect by an unknown mechanism.

Mesalamine (Asacol, Lialda, Apriso)

Products such as mesalamine, which releases 5-ASA in the distal small bowel secondary to pH changes, are more useful in patients with small intestinal Crohn disease. Long-term maintenance with mesalamine may delay clinical relapse. This agent is better tolerated than sulfasalazine and has fewer adverse effects.

Sulfasalazine (Azulfidine)

Sulfasalazine is useful mainly in colonic disease because the active compound, 5-ASA, is released in the large bowel by bacterial degradation of the parent compound. Sulfasalazine does not alleviate small bowel disease; it acts locally in the colon to reduce the inflammatory response and systemically inhibits prostaglandin synthesis. It has no additive or steroid-sparing effects when used in conjunction with corticosteroids. In contrast to its action in ulcerative colitis, sulfasalazine does not seem to maintain remission in Crohn disease.

Balsalazide (Colazal)

Balsalazide is an active component of sulfasalazine and is metabolized to mesalamine by intestinal flora. It has an anti-inflammatory effect, but its exact mechanism of action is not known. Balsalazide is used to treat ulcerative colitis.


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