Characterization of remission levels in patients with ulcerative colitis treated with 5-aminosalicylates: results of the cross-sectional CARUC-ASA study by the Belgian IBD Research and Development Group.

Authors

Catherine Reenaers, Guy Lambrecht, Lieven Pouillon, Filip Baert, Anneline Cremer, Arnaud Colard, Christophe Claessens, Thomas Billiet, Jeroen Geldof, Astrid De Zutter, Jean-François Rahier, Michael Somers, Dries Reynders, Laura Vansteenkiste, Ingrid Arijs, Edouard Louis, Belgian IBD Research and Development Group (BIRD), Bram Verstockt

Published in

Journal of Crohn's & colitis. Volume 20. Issue 8. Aug 05, 2026.

Abstract

5-Aminosalicylic acid (5-ASA) remains the first-line therapy for mild-to-moderate ulcerative colitis (UC). Modern treatment goals extend beyond symptom control to include steroid-free remission, endoscopic healing, and biomarker normalization. Real-world evidence on 5-ASA's ability to achieve these targets is limited. This study assessed remission levels and associated factors in Belgian UC patients in clinical remission on 5-ASA.
This cross-sectional, multicenter, phase 4 study included UC patients in clinical remission (PRO-2 ≤ 1, no rectal bleeding) treated with 5-ASA for ≥6 months. Patients receiving corticosteroids, immunomodulators, or advanced therapies were excluded. Outcomes were complete clinical remission (PRO-2 = 0, no urgency), endoscopic remission (MES ≤ 1, UCEIS ≤ 1), complete endoscopic remission (MES = 0), histological remission (Geboes 0-1), biological remission (fecal calprotectin <150 µg/g), and deep remission (clinical, endoscopic, and histological). Adherence was assessed using MARS-5.
In total, 198 patients were enrolled (median age 50 years; 41% female). Treatment was oral 5-ASA only (n = 134, 68%), rectal only (n = 19, 9%), or combination (n = 45, 23%). Biological remission was observed in 78%, endoscopic remission in 87%, complete endoscopic remission in 70%, and histological remission in 80%. Deep remission occurred in 24%, limited by persistent urgency (63%). Adherence was high (median MARS-5: 24). Oral 5-ASA only was significantly associated with endoscopic remission (P < .001).
In this real-world Belgian cohort, patients in clinical remission on 5-ASA achieved high rates of objective remission, while deep remission was low because of persistent urgency. These findings confirm 5-ASA's continued relevance in mild-to-moderate UC and highlight the importance of addressing residual symptoms despite mucosal healing.

PMID:
42572012
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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