Gravina AG, Pellegrino R, Federico A. Prudence is never excessive: Caution warranted in 5-aminosalicylic acid derivatives withdrawal for ulcerative colitis. World J Gastroenterol 2025; 31(44): 113253 [DOI: 10.3748/wjg.v31.i44.113253]
Corresponding Author of This Article
Raffaele Pellegrino, MD, Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via L. de Crecchio, Naples 80138, Italy. raffaele.pellegrino@unicampania.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 28, 2025 (publication date) through Dec 1, 2025
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Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Gravina AG, Pellegrino R, Federico A. Prudence is never excessive: Caution warranted in 5-aminosalicylic acid derivatives withdrawal for ulcerative colitis. World J Gastroenterol 2025; 31(44): 113253 [DOI: 10.3748/wjg.v31.i44.113253]
Antonietta Gerarda Gravina, Raffaele Pellegrino, Alessandro Federico, Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples 80138, Italy
Co-first authors: Antonietta Gerarda Gravina and Raffaele Pellegrino.
Author contributions: Gravina AG and Pellegrino R contributed equally by collecting the literature, writing the initial manuscript, and conceptualizing the structure of the text; they contributed equally to this manuscript and are co-first authors; Gravina AG, Pellegrino R, and Federico A critically revised the manuscript for important intellectual content and read and approved the final version.
Conflict-of-interest statement: Pellegrino R has received sponsorship for participation in national and/or international conferences from Pfizer Inc., Eli Lilly, Alfasigma, and AbbVie. Gravina AG has conducted training activities (e.g., ECM, preceptorship) for Pfizer, Galapagos Biopharma, and AbbVie. The remaining authors have no conflicts of interest to declare. Federico A has no direct or indirect conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raffaele Pellegrino, MD, Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via L. de Crecchio, Naples 80138, Italy. raffaele.pellegrino@unicampania.it
Received: August 20, 2025 Revised: October 2, 2025 Accepted: October 23, 2025 Published online: November 28, 2025 Processing time: 100 Days and 13 Hours
Abstract
This invited commentary discusses the recent study by Atay et al, which investigated relapse rates following the spontaneous withdrawal of maintenance 5-aminosalicylates in ulcerative colitis. The discussion focuses, in this patient setting, on the possible reasons that might prompt clinicians to pursue such exit strategies, and on the importance of exercising caution in these decisions, given the extremely narrow subsets of patients for whom international guidelines allow any degree of leeway.
Core Tip: The discontinuation of 5-aminosalicylates in ulcerative colitis should be considered only in highly selected, low-risk patients. Notwithstanding this requirement, however, the evidence generated to date does not yet permit the formulation of a robust and definitive operational pathway. Strict monitoring and adherence to European Crohn’s and Colitis Organisation guidelines remain essential to balance the potential benefits against the risks of relapse and colorectal cancer.
