Outcomes of 5-aminosalicylates withdrawal due to non-adherence in ulcerative colitis patients: A step toward evaluating intermittent therapy.

Background: 5-aminosalicylates (5-ASA) are the primary treatment for mild to moderate ulcerative colitis (UC). Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.

Aim: To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.

Methods: Adult patients with UC who were followed up between July 2019 and April 2025 were screened. Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.

Results: Among 880 patients with UC, 30 (3.4%) had 5-ASA withdrawal due to non-adherence while in remission on monotherapy. Twelve patients (40%) had disease relapse after a median of 20 months. The rate of patients in remission was 89% in the first year, decreasing to 73% in the second year, and to 64% in the third year. There were no significant differences between patients with and without relapse in terms of demographics, disease extent, remission duration before 5-ASA withdrawal, previous medications, steroid dependence, 5-ASA formulation, baseline inflammatory markers, or partial and endoscopic Mayo scores. Most patients (75%) who experienced relapse were successfully treated with 5-ASA monotherapy, while one-fourth of them required corticosteroids. No patients required biologic agents, hospitalization, or surgical intervention.

Conclusion: Intermittent therapy may be safe and feasible for UC patients, especially those in long-term remission, with treatment interruption up to one year considered acceptable.