Sex-specific differences in the efficacy and prognosis of 5-aminosalicylic acid therapy for ulcerative colitis: A 20-year retrospective cohort study

doi:10.3748/wjg.v32.i22.118036

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jun 14, 2026; 32(22): 118036
Published online Jun 14, 2026. doi: 10.3748/wjg.v32.i22.118036

Table 1 Baseline characteristics of female and male ulcerative colitis patients receiving 5-aminosalicylic acid treatment before and after propensity score matching, mean ± SD/n (%)

	Before PSM			After PSM
	Female cohort (n = 243)	Male cohort (n = 311)	SMD	Female cohort (n = 177)	Male cohort (n = 177)	SMD
Demographics
Follow-up period (years)	10.2 ± 8.4	8.7 ± 7.2	0.19	9.0 ± 7.0	9.5 ± 7.7	0.07
Age at onset (years)	34.8 ± 11.3	36.2 ± 13.5	0.11	34.8 ± 11.3	33.9 ± 12.5	0.08
Disease duration (years)	14.0 ± 8.3	12.9 ± 7.0	0.67	12.9 ± 6.9	13.4 ± 7.5	0.07
Smoker	4 (1.6)	126 (40.5)	1.08	4 (2.3)	5 (2.8)	0.04
BMI ≥ 24 kg/m²	98 (40.3)	183 (58.8)	0.38	77 (43.5)	85 (48.0)	0.09
Comorbid conditions
Diabetes mellitus	13 (5.3)	28 (9)	0.14	11 (6.2)	13 (7.3)	0.04
Hypertension	19 (7.8)	44 (14.1)	0.2	13 (7.3)	15 (8.5)	0.04
NAFLD	8 (3.3)	13 (4.2)	0.05	4 (2.3)	5 (2.8)	0.04
EIMs	36 (14.8)	48 (15.4)	0.02	18 (10.2)	21 (11.9)	0.05
Opportunistic infections¹	69 (28.4)	69 (22.2)	0.14	46 (26)	40 (22.6)	0.08
Disease conditions at onset
DAI
Mild to moderate	136 (56.0)	164 (52.7)	0.06	101 (57.1)	100 (56.5)	0.01
Severe	107 (44.0)	147 (47.3)	0.06	76 (42.9)	77 (43.5)	0.01
Disease extent
Proctitis	52 (21.4)	71 (22.8)	0.03	38 (21.5)	39 (22.0)	0.01
Proctosigmoiditis	87 (35.8)	76 (24.4)	0.25	58 (32.8)	50 (28.2)	0.1
Pancolitis	104 (42.8)	164 (52.7)	0.2	81 (45.8)	88 (49.7)	0.08
Labs
C-reactive protein (mg/L)	15.5 ± 30.9	15.1 ± 29.2	0.01	14.9 ± 28.8	17.5 ± 35.0	0.08
Accompanying medication
Aspirin	1 (0.4)	14 (4.5)	0.27	1 (0.6)	1 (0.6)	0
Lipid-lowering drugs	7 (2.9)	16 (5.1)	0.12	4 (2.3)	4 (2.3)	0
Antibiotic	99 (40.7)	102 (32.8)	0.17	66 (37.3)	60 (33.9)	0.07
5-ASA regimen
Oral 5-ASA dose/day
≤ 2 g	66 (27.2)	88 (28.3)	0.03	49 (27.7)	51 (28.8)	0.03
> 2 g	177 (72.8)	223 (71.7)	0.03	128 (72.3)	126 (71.2)	0.03
Number of oral 5-ASA treatments/day
1-2	107 (44.0)	136 (43.7)	0.006	82 (46.3)	80 (45.2)	0.02
> 2	136 (56.0)	175 (56.3)	0.006	95 (53.7)	97 (54.8)	0.02
Combination of enema and suppository	124 (51.0)	151 (48.6)	0.05	84 (47.5)	86 (48.6)	0.02
UC medication use²
Systemic steroids	188 (77.4)	224 (72)	0.12	132 (74.6)	125 (70.6)	0.09
Any steroid	194 (79.8)	229 (73.6)	0.15	135 (76.3)	127 (71.8)	0.1
Immunomodulators	95 (39.1)	102 (32.8)	0.13	63 (35.6)	67 (37.9)	0.05
Biologics	51 (21.0)	47 (15.1)	0.15	34 (19.2)	28 (15.8)	0.08

¹Intestinal infections caused by Clostridioides difficile, cytomegalovirus, and Epstein-Barr virus.

²Simultaneous or subsequent use on prescription of 5-aminosalicylic acid.

SMD: Standard mean difference; PSM: Propensity score matching; BMI: Body mass index; NAFLD: Non-alcoholic fatty liver disease; DAI: Disease activity index; EIMs: Extraintestinal manifestations; UC: Ulcerative colitis; 5-ASA: 5-aminosalicylic acid.

Full Size Table

Table 2 Comparison of 5-aminosalicylic acid therapy outcomes between the female and male cohorts after 1:1 propensity score matching, n (%)

	Female cohort (n = 177)	Male cohort (n = 177)	aOR	95%CI	P value
Frequency of UC flare-ups per year
≤ 2	145 (81.9)	110 (62.1)	2.78	1.69-4.55	< 0.001
> 2	32 (18.1)	67 (37.9)	2.78	1.69-4.55	< 0.001
EMR (n = 173)	83 (46.9)	90 (50.8)	1.17	0.77-1.78	0.46
EMH (n = 72)	45 (25.4)	29 (16.4)	0.58	0.34-0.97	0.04
Serious complications (n = 60)	25 (14.1)	35 (19.8)	1.5	0.85-2.63	0.16
Colectomy (n = 59)	22 (12.4)	37 (20.9)	1.86	1.05-3.31	0.03
Malignancies¹ (n = 23)	9 (5.1)	14 (7.9)	1.6	0.68-3.81	0.29

¹Colorectal cancers and extra-colorectal malignancies.

UC: Ulcerative colitis; aOR: Adjusted odds ratio; CI: Confidence interval; EMR: Endoscopic mucosal remission; EMH: Endoscopic mucosal healing.

Full Size Table

Table 3 Univariate and multivariate Cox regression analysis of endoscopic mucosal healing and colectomy in ulcerative colitis patients receiving 5-aminosalicylic acid treatment after 1:1 propensity score matching

Variables	Univariate analysis				Multivariate analysis
	EMH (n = 72)		Colectomy (n = 59)		EMH (n = 72)		Colectomy (n = 59)
	aHR (95%CI)	P value	aHR (95%CI)	P value	aHR (95%CI)	P value	aHR (95%CI)	P value
Male sex	0.63 (0.39-1.00)	0.05	1.80 (1.06-3.05)	0.03	0.58 (0.36-0.94)	0.03	1.93 (1.13-3.29)	0.02
Age at onset	1.00 (0.98-1.02)	0.66	1.03 (1.01-1.05)	0.004	0.99 (0.97-1.01)	0.55	1.03 (1.01-1.05)	0.01
Disease duration	0.80 (0.75-0.86)	< 0.001	0.95 (0.90-0.99)	0.02	0.81 (0.76-0.87)	0.00	0.94 (0.9-0.99)	0.02
Smoker	1.04 (0.25-4.23)	0.96	1.3 (0.32-5.34)	0.72	1.24 (0.30-5.21)	0.77
BMI ≥ 24 kg/m²	0.68 (0.43-1.08)	0.11	1.58 (0.93-2.68)	0.09	0.83 (0.52-1.35)	0.46	1.40 (0.81-2.40)	0.23
Disease extent	1.03 (0.78-1.37)	0.84	1.19 (0.86-1.65)	0.3	0.97 (0.73-1.30)	0.86
Advanced therapy¹	0.47 (0.29-0.74)	0.001	1.45 (0.75-2.79)	0.27	0.51 (0.32-0.83)	0.01

¹Simultaneously using or subsequent addition of systemic steroid, immunosuppressants, or biologics to 5-aminosalicylic acid prescription.

BMI: Body mass index; aHR: Adjusted hazard ratio; CI: Confidence interval; EMH: Endoscopic mucosal healing.

Full Size Table

Citation: 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
URL: https://www.wjgnet.com/1007-9327/full/v32/i22/118036.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i22.118036

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]

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