Risk factors and management strategies associated with non-response to aminosalicylates for maintenance treatment in ulcerative colitis.

Aminosalicylates (5-ASA) represent the first-line maintenance treatment in patients with mild-moderate ulcerative colitis (UC). Early identification of patients at high risk for 5-ASA non-response, along with appropriate therapeutic escalation, are essential to avoid disease progression; however, the absence of a standardized definition for treatment success makes this task challenging. The focus of the current review is to describe the risk factors and management strategies associated with 5-ASA non-response. Rates of 5-ASA failure can vary from 17% to 75% according to different success definitions, of which clinical relapse is the most prevalent and studied condition. Younger age and endoscopic activity at diagnosis, extensive colitis, early need for corticosteroids, elevated inflammatory markers and non-adherence are consistent risk factors of 5-ASA failure. Given the effectiveness, safety profile and tolerability of this medication, therapy optimization is critical before treatment escalation. Combined use of systemic and topical therapy at appropriate doses in once-daily administration, along with control of adherence, could improve success rates.