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

Reenaers, Catherine;Lambrecht, Guy;Pouillon, Lieven;Baert, Filip;Verstockt, Bram;et.al.
(2026) Journal of Crohn’s and Colitis — Vol. 20, n° 8, p. jjag100 (2026)

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  • Reenaers, Catherineorcid-logoDepartment of Gastroenterology, University Hospital of Liège, Liège University , Liège,
    Author
  • Lambrecht, GuyDepartment of Gastroenterology, AZ Oostende , Oostende,
    Author
  • Pouillon, LievenDepartment of Gastroenterology, Imelda Bonheiden , Bonheiden,
    Author
  • Baert, FilipDepartment of Gastroenterology, AZ Delta , Roeselare,
    Author
  • Rahier, Jean-FrançoisUCLouvain
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  • Verstockt, Bram
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Abstract
Background: 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. Methods: 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. Results: 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). Conclusion: 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.
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Reenaers, C., Lambrecht, G., Pouillon, L., Baert, F., Cremer, A., Colard, A., Claessens, C., Billiet, T., Geldof, J., De Zutter, A., Rahier, J.-F., Somers, M., Reynders, D., Vansteenkiste, L., Arijs, I., Louis, E., & Verstockt, B. (2026). 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. Journal of Crohn’s and Colitis, 20(8), jjag100. https://doi.org/10.1093/ecco-jcc/jjag100 (Original work published 2026)