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Treatment of Ulcerative Colitis with 5-Aminosalicylic Acid
- Lloyd R. Sutherland, MD;
- Gary May, MD; and
- Eldon Shaffer, MD
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IN RESPONSE:
Dr. Sninsky highlights a few of the difficulties and arbitrary decisions often required when conducting a meta-analysis of studies that differ in form, entry criteria, definitions of outcome, and design. We intentionally included in the meta-analysis studies of Dipentum and Pentasa that combined remission and improvement; to exclude such studies would have resulted in an unacceptable loss of patient data. In our discussion, we stated that no 5-aminosalicylic acid preparation was superior to another; however, in response to Dr. Sninsky's comments, we created a new Table 1, which reports all studies comparing 5-aminosalicylic acid with placebo in terms of the combined complete remission and improvement data. Although our results reflect the data of Schroeder and colleagues [1], our results for Dr. Sninsky's study [2] are not as optimistic because we used the more conservative intention-to-treat analysis rather than the per-protocol analysis. The pooled odds ratio for the combined data, 2.16 (95% CI, 1.73 to 2.78), is essentially unchanged.
Difficulties in analyzing the data underscore the lack of a universally accepted disease activity index. Although Sninsky and colleagues used a composite scoring system, it has not yet been validated in any other study. Our dose-response data support Dr. Sninsky's contention that higher doses of any 5-ASA offer an important therapeutic advantage for patients with active ulcerative colitis.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
