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This is important to address: 5\u2010ASA therapy accounts for up to 25% of total healthcare costs in ulcerative colitis (UC), while almost a third of patients with Crohn's disease (CD) receive long\u2010term 5\u2010ASA despite no clear evidence of benefit. Further, rationalising medication burden may improve overall adherence and outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To summarise the rationale for 5\u2010ASA withdrawal, review the current evidence in both UC and CD and consider the data surrounding colorectal cancer (CRC) prevention, guiding an evidence\u2010based withdrawal strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed was searched to identify relevant studies. Only papers published in English were reviewed, with priority given to randomised clinical trials and meta\u2010analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For patients with UC, consideration of 5\u2010ASA withdrawal should be made on a case\u2010by\u2010case basis, but it appears safest for those in deep remission without any of the following risk factors: younger age (&lt;40\u00a0years), remission for less than 2\u00a0years, a history of multiple flares, extensive disease. 5\u2010ASA withdrawal should also be considered in patients with UC escalated to biologic therapy who have achieved remission and in all patients with CD. Although 5\u2010ASA therapy may have chemopreventive benefits for CRC, the cost\u2010benefit ratio appears significant, and this indication is not justified by evidence in those who have achieved remission and are continuing therapy with other agents, or in those in sustained remission without a history of extensive disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the majority of patients with IBD receive 5\u2010ASA during their disease course, safe withdrawal appears possible in many, with important implications for both health economics and patient experience. A number of unanswered questions, however, remain.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.15771","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T09:34:08Z","timestamp":1590485648000},"page":"73-84","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Review article: withdrawal of 5\u2010aminosalicylates in inflammatory bowel disease"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5298-4780","authenticated-orcid":false,"given":"Thomas P.","family":"Chapman","sequence":"first","affiliation":[{"name":"Translational Gastroenterology Unit Nuffield Department of Experimental Medicine University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2096-2744","authenticated-orcid":false,"given":"Catarina","family":"Frias Gomes","sequence":"additional","affiliation":[{"name":"Surgical Department Gastroenterology Division Hospital Beatriz \u00c2ngelo Loures Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard","family":"Louis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology CHU Li\u00e8ge University Hospital Li\u00e8ge Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Fr\u00e9d\u00e9ric","family":"Colombel","sequence":"additional","affiliation":[{"name":"The Dr. Henry D. 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