Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2017; 23(16): 2995-3002
Published online Apr 28, 2017. doi: 10.3748/wjg.v23.i16.2995
Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice
Shomron Ben-Horin, Jane M Andrews, Konstantinos H Katsanos, Florian Rieder, Flavio Steinwurz, Konstantinos Karmiris, Jae Hee Cheon, Gordon William Moran, Monica Cesarini, Christian D Stone, Doron Schwartz, Marijana Protic, Xavier Roblin, Giulia Roda, Min-Hu Chen, Ofir Har-Noy, Charles N Bernstein
Shomron Ben-Horin, Ofir Har-Noy, Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat-Gan 52621, Israel
Shomron Ben-Horin, Min-Hu Chen, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510700, Guangdong province, China
Jane M Andrews, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Service, Royal Adelaide Hospital, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
Konstantinos H Katsanos, Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina 45500, Greece
Florian Rieder, Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44109, United States
Flavio Steinwurz, Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, SP 05652-900, Brazil
Konstantinos Karmiris, Department of Gastroenterology, Venizeleio General Hospital, Heraklion, 71409 Crete, Greece
Jae Hee Cheon, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, South Korea
Gordon William Moran, NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham NG7 2UH, United Kingdom
Monica Cesarini, Dipartimento di Medicina Interna e Specialità Mediche, “Sapienza”, University of Rome, 00185 Roma, Italy
Christian D Stone, Comprehensive Digestive Institute of Nevada, Las Vegas, NV 89113, United States
Doron Schwartz, Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 6400111, Israel
Marijana Protic, Department of Gastroenterology, University Hospital Zvezdara, Belgrade 11000, Serbia
Xavier Roblin, Department of Gastroenterology, University-Hospital of Saint-Etienne, 42100 Saint Etienne, France
Giulia Roda, Gastroenterology Unit, S. Orsola-Malpighi, 40138 Bologna, Italy
Charles N Bernstein, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB R3T2N2, Canada
Author contributions: Ben-Horin S designed the study and drafted the manuscript; Andrews JM, Katsanos KH, Rieder F, Steinwurz F, Karmiris K, Cheon JH, Moran GW, Cesarini M, Stone CD, Schwartz D, Protic M, Roblin X, Roda G, Chen MH, Har-Noy O and Bernstein CN collected the results, participated in data analysis and interpretation and in critical review of the manuscript for important intellectual content.
Institutional review board statement: The study was approved by Sheba Medical center ethics review board (decision NO. 3456-16-SMC). The approval is attached as separate file.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment. Statement is attached also as a separate file.
Conflict-of-interest statement: Ben-Horin S has received consultancy and/or advisory board fees from Schering-Plough, AbbVie, Celltrion, Pfizer, Ferring, Janssen and Takeda; and has received research support from Celltrion, AbbVie and Takeda. Katsanos KH has received consultancy and/or advisory board fees from AbbVie, AENORASIS, MSD and Takeda. Rieder F has received consultancy and/or advisory board fees from AbbVie and UCB and is on the speakers bureau for AbbVie. Har-Noy O has received research support from Ferring. Bernstein CN is supported in part by the Bingham Chair in Gastroenterology. He has served on advisory boards for Abbvie Canada, Ferring Canada, Janssen Canada, Shire Canada, Pfizer Canada and Takeda Canada. He has consulted to Mylan Pharmaceuticals and Bristol Myers Squibb. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Shire Canada, and Takeda Canada. He has been on speaker’s bureau for Abbvie Canada and Shire Canada. Protic M has received consultancy fees from MSD, AbbVie and Sandoz. JMA has served on Advisory Boards, prepared educational material and/or spoken at medical education meetings for Abbvie, Abbott, Aspen, AstraZeneca, Ferring, Janssen, MSD, Pfizer, Shire, Takeda, Hospira. She has received research funding (in last 36 months) via her institution from Abbvie, Gutsy Foundation, NMHRC, Janssen. Moran GW has received: Consultancy fees from AbbVie, Takeda Pharmaceuticals, Janssen and Dr Falk; Speaker fees from Merck Sharp, Dohme Ltd, AbbVie, Ferring and Takeda Pharmaceuticals and Financial support for educational activities from AbbVie, Merck Sharp, Dohme Ltd, Ferring and Dr Falk. Steinwurz F has received research support and/or advisory board/speaker fees from Abbvie, Astrazeneca, Ferring, Gilead, Janssen, Pfzier, Takeda, UCB. Karmiris K has received speaker’s and/or advisory board fees from Abbvie, MSD and Takeda. Roblin X has received research support and/or advisory board/speaker fees from Abbvie, Ferring, Janssen, Takeda, MSD, Abbvie. Chen MH has received speaker fees from Xian-Janssen, Beaufour Ipsen (Tianjin China), Abbvie and Takeda. Schwartz D has received consultancy fees from Rafa Ltd and Janssen and speakers fee from Abbvie and Takeda. Stone CD received speaker's fees from Abbvie, Janssen, Shire, Takeda. The other authors have no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at shomron.benhorin@gmail.com. Participants consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low. Statement is attached also as a separate file.
Open-Access: 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/
Correspondence to: Shomron Ben-Horin, MD, Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Hashomer, Ramat-Gan 52621, Israel. shomron.benhorin@gmail.com
Telephone: +972-3-5302694 Fax: +972-3-5303160
Received: December 25, 2016
Peer-review started: December 26, 2016
First decision: January 19, 2017
Revised: January 31, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: April 28, 2017
Processing time: 124 Days and 4.3 Hours
Core Tip

Core tip: Patients with moderate-severe active ulcerative colitis are often treated with corticosteroids. Whether 5-aminosalycilates (5ASA) offer any benefit when combined with corticosteroids for these patients has not been explored. This global survey among expert gastroenterology physicians in 12 countries shows division of opinion regarding this treatment choice, but demonstrates that the majority of doctors administer corticosteroids with continued 5ASA, despite the absence of evidence supporting this combination. If this “crowd wisdom” is correct and the addition of 5ASA offers even small added benefit for these severely sick patients, this could comprise an important simple tool for improving outcomes in acute ulcerative colitis. The results of this survey call for the need for a controlled clinical trial to examine this treatment choice.