{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T22:29:47Z","timestamp":1783636187367,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Sulfasalazine (SZ) and 5\u2010aminosalicylates (5\u2010ASA) have been widely used treatments for ulcerative colitis (UC). Although some studies suggest SZ may be superior, limited data exists comparing the two in children. This study aimed to describe real\u2010world data on their comparative safety and efficacy in children and the impact of switching between SZ and 5\u2010ASA before treatment escalation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed the electronic medical records of children diagnosed with UC between June 1999 and December 2019 at Boston Children's Hospital. We described outcomes at 1 year and long\u2010term in patients treated with SZ or 5\u2010ASA as a first\u2010line maintenance agent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 433 patients (age 0\u201319 years), 124 started on SZ and 309 on 5\u2010ASA. Forty\u2010eight patients switched between the two drugs within the first year, and 74 switched during long\u2010term follow\u2010up. The main reason for switching from SZ to 5\u2010ASA was adverse reactions. At 1 year, 54%, 44.3%, and 36.6% of patients on SZ, 5\u2010ASA, and those who switched, respectively, were in steroid\u2010free remission (<jats:italic>p<\/jats:italic>\u2009=\u20090.13). Patients who switched due to lack of efficacy or adverse reactions were four times more likely to escalate treatment compared to nonmedical reasons. Patients with Pediatric Ulcerative Colitis Activity Index &gt;65 at the diagnosis are more likely to require treatment escalation (<jats:italic>p<\/jats:italic>\u2009=\u20090.0043).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SZ and 5\u2010ASA are effective first\u2010line treatments for mild to moderate pediatric UC. SZ tends to have more minor adverse reactions. Switching between SZ and 5\u2010ASA does not offer therapeutic benefits, and disease severity at diagnosis predicts early treatment escalation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.70041","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T07:11:27Z","timestamp":1744269087000},"page":"988-997","source":"Crossref","is-referenced-by-count":3,"title":["Clinical outcomes of maintenance therapy with sulfasalazine compared to 5\u2010aminosalicylates in children with ulcerative colitis"],"prefix":"10.1002","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1346-2304","authenticated-orcid":false,"given":"Ishrat","family":"Mansuri","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Boston Children's 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