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Observational Study
. 2023 Apr 1;76(4):460-467.
doi: 10.1097/MPG.0000000000003698. Epub 2022 Dec 28.

Efficacy and Safety of Sulfasalazine Suspension in Children With Ulcerative Colitis

Ishrat Mansuri  1 , Sophia Wang  1 , Paul A Rufo  1 , Enju Liu  1   2 , Christina Chan  2 , Athos Bousvaros  1
Affiliations
Observational Study

Efficacy and Safety of Sulfasalazine Suspension in Children With Ulcerative Colitis

Ishrat Mansuri et al. J Pediatr Gastroenterol Nutr. .

Abstract

Background: Sulfasalazine (SZ) is commonly used to treat pediatric ulcerative colitis (UC). SZ can be compounded into a suspension form which is beneficial for children with difficulty swallowing a pill. Despite being utilized for over 40 years, there is a lack of published data on the efficacy and safety of SZ suspension in children with UC. Recently, third-party payors have begun refusing to pay for SZ suspension due to lack of data.

Methods: In this retrospective study, we reviewed the electronic medical records of patients ages <18 years diagnosed with UC from June 1999 to December 2019 at Boston Children's Hospital and treated with SZ suspension as a first-line agent. We obtained demographics, clinical, and endoscopic data to measure outcomes at 1 year and long term.

Results: Of 57 patients treated with SZ suspension, 52 (91%) had a follow-up and 26 of 52 (50%) remained in steroid-free remission at 1 year. Two patients were switched to SZ tablets due to nonmedical reasons and 11 (21%) required rescue treatment (2 infliximab, 1 tacrolimus, 8 6-mercaptopurine/azathioprine) within a year. Three required colectomy within a year and 5 in long term. Four (8%) developed nonserious adverse reactions and switched to 5-aminosalicylates (5-ASA) by 1 year. The median duration of long-term follow-up was 36 months (range, 2-205 months) with 28 requiring treatment escalation in long term.

Conclusions: SZ suspension is a safe and effective treatment for UC in children with difficulty swallowing a pill. The 1-year remission rate on this treatment is comparable to 5-ASA utilized in children.

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Conflict of interest statement

The authors report no conflicts of interest.

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