Liu ZS, Tang H, Zhang HM, Bai XY, Yang H, Li XF, Qian JM. Sex-specific differences in the efficacy and prognosis of 5-aminosalicylic acid therapy for ulcerative colitis: A 20-year retrospective cohort study. World J Gastroenterol 2026; 32(22): 118036 [DOI: 10.3748/wjg.v32.i22.118036]
Corresponding Author of This Article
Jia-Ming Qian, MD, Professor, Department of Gastroenterology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. qianjm@pumch.cn
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Liu ZS, Tang H, Zhang HM, Bai XY, Yang H, Li XF, Qian JM. Sex-specific differences in the efficacy and prognosis of 5-aminosalicylic acid therapy for ulcerative colitis: A 20-year retrospective cohort study. World J Gastroenterol 2026; 32(22): 118036 [DOI: 10.3748/wjg.v32.i22.118036]
Zhao-Shi Liu, Xiao-Feng Li, Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China
Zhao-Shi Liu, Hao Tang, Xiao-Yin Bai, Hong Yang, Jia-Ming Qian, Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
Hui-Min Zhang, Department of Gastroenterology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou 450003, Henan Province, China
Author contributions: Liu ZS wrote the original draft; Liu ZS, Tang H, and Qian JM designed the study; Liu ZS, Tang H, and Zhang HM were responsible for developing the methodology; Liu ZS, Zhang HM, Bai XY, and Li XF collected and analyzed data; Liu ZS, Tang H, and Bai XY performed statistical analysis; Yang H, and Qian JM participated in the review and editing; all authors approved the final version.
Supported by the Health Research and Special Projects Grant of China, No. 201002020; and CAMS Innovation Fund for Medical Sciences, No. 2016-I2M-3-001.
Institutional review board statement: This study was approved by the Institutional Ethics Committee of Peking Union Medical College Hospital (Ethics approval No. S-K1889).
Informed consent statement: Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.
Corresponding author: Jia-Ming Qian, MD, Professor, Department of Gastroenterology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. qianjm@pumch.cn
Received: December 26, 2025 Revised: February 13, 2026 Accepted: March 9, 2026 Published online: June 14, 2026 Processing time: 156 Days and 12.7 Hours
Abstract
BACKGROUND
Despite 5-aminosalicylic acid (5-ASA) being the first-line therapy for ulcerative colitis (UC), there is limited real-world evidence concerning sex-specific differences in the efficacy of 5-ASA therapy and patient prognosis.
AIM
To investigate sex-disparities in 5-ASA treatment responses and long-term outcomes in a Chinese large-scale UC cohort.
METHODS
A retrospective study was conducted on 554 consecutive UC patients treated with 5-ASA at Peking Union Medical College Hospital between January 2003 and June 2023. The rates of endoscopic mucosal healing (EMH) and colectomy were compared between the female and male cohorts, and 1:1 propensity score matching (PSM) was performed for demographics, comorbid conditions and drugs, disease conditions, laboratory parameters, and UC medication use. Cox regression analysis and Kaplan-Meier curves were constructed for survival analyses.
RESULTS
There were 243 patients in the female cohort (mean age, 34.8 ± 11.3 years; 21.4% with ulcerative proctitis) and 311 patients in the male cohort (mean age, 36.2 ± 13.5 years; 22.8% with ulcerative proctitis). After PSM, there was a higher risk of UC flare-up in the male vs female cohort [adjusted odds ratio = 2.78, 95% confidence interval (CI): 1.69-4.55, P < 0.001]. Male sex was an independent protective factor against EMH [adjusted hazard ratio (aHR) = 0.89, 95%CI: 0.87-0.91, P = 0.03] and a risk factor for colectomy (aHR = 1.93, 95%CI: 1.13-3.29, P = 0.02). Male patients had longer EMH-free survival (aHR = 0.63, 95%CI: 0.39-1.00, P = 0.048) and shorter colectomy-free survival (aHR = 1.80, 95%CI: 1.06-3.05, P = 0.027).
CONCLUSION
Pronounced sex-specific differences exist in 5-ASA therapy efficacy and patient prognosis. Male sex is associated with more frequent relapses, a lower likelihood of EMH, and a higher risk of colectomy.
Core Tip: Real-world data concerning sex-specific differences in the response to and long-term outcomes of 5-aminosalicylic acid (5-ASA) therapy for ulcerative colitis (UC) in large-scale UC cohorts are lacking. This retrospective study analyzed 354 patients receiving 5-ASA treatment after 1:1 propensity score matching. Male patients had an increased chance of frequent UC flare-ups, less frequent and delayed endoscopic mucosal healing, and a higher risk of surgery. These findings emphasize the need for sex-adapted therapeutic strategies to optimize 5-ASA utilization and improve individualized UC management.
