{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T17:02:12Z","timestamp":1772211732532,"version":"3.50.1"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Useful indices to determine whether to reduce the dose of 5-aminosalicylic acid (5-ASA) in patients with ulcerative colitis (UC) during remission remain unclear. We aimed to analyze the rate and risk factors of relapse after reducing the dose of oral 5-ASA used for maintenance therapy of UC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>UC patients whose 5-ASA dose was reduced in clinical remission (partial Mayo score of \u2264 1) at our institution from 2012 to 2017 were analyzed. Various clinical variables of patients who relapsed after reducing the dose of oral 5-ASA were compared with those of patients who maintained remission. Risk factors for relapse were assessed by univariate and multivariate logistic regression analyses. Cumulative relapse-free survival rates were calculated using the Kaplan\u2013Meier method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 70 UC patients were included; 52 (74.3%) patients maintained remission and 18 (25.7%) patients relapsed during the follow-up period. Multivariate analysis indicated that a history of acute severe UC (ASUC) was an independent predictive factor for clinical relapse (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.024, odds ratio: 21, 95% confidence interval: 1.50\u2013293.2). Based on Kaplan\u2013Meier survival analysis, the cumulative relapse-free survival rate within 52 weeks was 22.2% for patients with a history of ASUC, compared with 82.0% for those without. the log-rank test showed a significant difference in a history of ASUC (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dose reduction of 5-ASA should be performed carefully in patients who have a history of ASUC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0255620","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T13:32:14Z","timestamp":1628083934000},"page":"e0255620","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictive factors of relapse after dose reduction of oral 5-aminosalicylic acid in patients with ulcerative colitis in the remission phase"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5876-2508","authenticated-orcid":true,"given":"Akira","family":"Madarame","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakatsu","family":"Fukuzawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiya","family":"Yamauchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin","family":"Kono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihiko","family":"Sugimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayato","family":"Yamaguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Morise","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohei","family":"Koyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumiko","family":"Uchida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Suguro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taisuke","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kagawa","family":"Yasuyuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kawai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"key":"pone.0255620.ref001","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/S0140-6736(16)32126-2","article-title":"Ulcerative colitis","volume":"389","author":"Ryan Ungaro","year":"2017","journal-title":"Lancet"},{"key":"pone.0255620.ref002","first-page":"2769","article-title":"Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies","volume":"390","author":"Siew C Ng","year":"2018","journal-title":"Lancet"},{"key":"pone.0255620.ref003","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.cgh.2017.06.016","article-title":"Natural history of adult ulcerative colitis in population-based cohorts: a systematic review","volume":"16","author":"Mathurin Fumery","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"pone.0255620.ref004","first-page":"CD000544","article-title":"Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis","volume":"5","author":"Yongjun Wang","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0255620.ref005","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1093\/ecco-jcc\/jjx009","article-title":"Third European evidence- based consensus on diagnosis and management of ulcerative colitis. Part 2: Current management","volume":"11","author":"Marcus Harbord","year":"2017","journal-title":"J Crohns Colitis"},{"key":"pone.0255620.ref006","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1365-2036.1992.tb00561.x","article-title":"Improved maintenance of remission in ulcerative colitis by balsalazide 4 g\/day compared with 2 g\/day","volume":"6","author":"M H Giaffer","year":"1992","journal-title":"Alimentary Pharmacology and Ther"},{"key":"pone.0255620.ref007","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1365-2036.2010.04537.x","article-title":"Randomised clinical trial: a comparative dose-finding study of three arms of dual release mesalazine for maintaining remission in ulcerative colitis","volume":"33","author":"W Kruis","year":"2011","journal-title":"Alimentary Pharmacology and Ther"},{"key":"pone.0255620.ref008","first-page":"108","article-title":"Randomised open label trial comparing two different dosages of oral mesalazine in the maintainence treatment of ulcerative colitis","volume":"1","author":"R Pica","year":"2012","journal-title":"Italian Journal of Medicine"},{"key":"pone.0255620.ref009","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/j.1365-2036.1992.tb00578.x","article-title":"Short report: comparison of two doses of balsalazide in maintaining ulcerative colitis in remission over 12 months","volume":"6","author":"J R Green","year":"1992","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0255620.ref010","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s00535-018-1439-1","article-title":"Evidence-based clinical practice guidelines for inflammatory bowel disease","volume":"53","author":"Katsuyoshi Matsuoka","year":"2018","journal-title":"J Gastroenterol"},{"key":"pone.0255620.ref011","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1056\/NEJM198712243172603","article-title":"Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis","volume":"317","author":"KW Schroeder","year":"1987","journal-title":"N Engl J Med"},{"key":"pone.0255620.ref012","doi-asserted-by":"crossref","first-page":"e0187737","DOI":"10.1371\/journal.pone.0187737","article-title":"The risk factor of clinical relapse in ulcerative colitis patients with low dose 5-aminosalicylic acid as maintenance therapy: A report from the IBD registry","volume":"12","author":"Tomohiro Fukuda","year":"2017","journal-title":"PLoS ONE"},{"key":"pone.0255620.ref013","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1136\/bmj.2.4947.1041","article-title":"Cortisone in ulcerative colitis; final report on a therapeutic trial","volume":"2","author":"SC Truelove","year":"1955","journal-title":"Br Med J"},{"key":"pone.0255620.ref014","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.crohns.2010.02.001","article-title":"The pattern and outcome of acute severe colitis","volume":"4","author":"Lotte C Dinesen","year":"2010","journal-title":"J Crohns Colitis"},{"key":"pone.0255620.ref015","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/ecco-jcc\/jjv047","article-title":"Association Between the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and Outcomes in Acute Severe Ulcerative Colitis","volume":"9","author":"Crispin Corte","year":"2015","journal-title":"J Crohns Colitis"},{"key":"pone.0255620.ref016","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1093\/ecco-jcc\/jjx008","article-title":"Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders","volume":"11","author":"Fernando Magro","year":"2017","journal-title":"J Crohns Colitis"},{"key":"pone.0255620.ref017","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/gut.4.4.299","article-title":"The course and prognosis of ulcerative colitis","volume":"4","author":"FC EDWARDS","year":"1963","journal-title":"Gut"},{"key":"pone.0255620.ref018","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1053\/j.gastro.2013.10.052","article-title":"Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis","volume":"146","author":"Remo Panaccione","year":"2014","journal-title":"Gastroenterology"},{"key":"pone.0255620.ref019","first-page":"CD000478","article-title":"Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis","volume":"5","author":"Antje Timmer","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0255620.ref020","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/ajg.2011.386","article-title":"Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements","volume":"107","author":"Alain Bitton","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"pone.0255620.ref021","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1111\/apt.15751","article-title":"Long-term outcome of patients with acute severe ulcerative colitis responding to intravenous steroids","volume":"51","author":"Robert Salameh","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0255620.ref022","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1097\/00042737-199511000-00003","article-title":"Comparison of the efficacy and safety of 1.5 compared with 3.0 g oral slow-release mesalazine (Pentasa) in the maintenance treatment of ulcerative colitis. Dutch Pentasa Study Group","volume":"7","author":"P Fockens","year":"1995","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"pone.0255620.ref023","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/00004836-199512000-00007","article-title":"Coated oral 5-aminosalicylic acid (Claversal) is equivalent to sulfasalazine for remission maintenance in ulcerative colitis. A double-blind study","volume":"21","author":"S Ardizzone","year":"1995","journal-title":"J Clin Gastroenterol"},{"key":"pone.0255620.ref024","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1053\/j.gastro.2009.08.069","article-title":"Delayed-release oral mesalamine 4.8 g\/day (800-mg tablet) is effective for patients with moderately active ulcerative colitis","volume":"137","author":"William J Sandborn","year":"2009","journal-title":"Gastroenterology"},{"key":"pone.0255620.ref025","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1136\/gut.31.2.179","article-title":"Why do patients with ulcerative colitis relapse?","volume":"31","author":"S A Riley","year":"1990","journal-title":"Gut"},{"key":"pone.0255620.ref026","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1111\/apt.12013","article-title":"Long-term oral mesalazine adherence and the risk of disease flare in ulcerative colitis: nationwide 10-year retrospective cohort from the veterans affairs healthcare system","volume":"36","author":"N Khan","year":"2012","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0255620.ref027","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1111\/apt.12396","article-title":"Maintaining stable symptom control in inflammatory bowel disease: a retrospective analysis of adherence, medication switches and the risk of relapse","volume":"38","author":"A Robinson","year":"2013","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0255620.ref028","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1097\/MIB.0b013e318280b1b8","article-title":"Long-term mesalamine maintenance in ulcerative colitis: which is more important? Adherence or daily dose","volume":"19","author":"Nabeel Khan","year":"2013","journal-title":"Inflamm Bowel Dis"},{"key":"pone.0255620.ref029","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1007\/s10620-007-9968-0","article-title":"Medication non-adherence is associated with increased medical health care costs","volume":"53","author":"S Kane","year":"2008","journal-title":"Dig Dis Sci"},{"key":"pone.0255620.ref030","first-page":"795","article-title":"Overcoming adherence issues in ulcerative colitis","volume":"3","author":"SV Kane","year":"2007","journal-title":"Gastroenterol Hepatol (N Y)"},{"key":"pone.0255620.ref031","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1136\/flgastro-2014-100514","article-title":"A UK cost of care model for inflammatory bowel disease","volume":"6","author":"Nivedita Ghosh","year":"2015","journal-title":"Frontline Gastroenterology"},{"key":"pone.0255620.ref032","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1053\/j.gastro.2011.06.054","article-title":"Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis","volume":"141","author":"Jean Fr\u00e9d\u00e9ric Colombel","year":"2011","journal-title":"Gastroenterology"},{"key":"pone.0255620.ref033","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.cgh.2016.01.015","article-title":"Mucosal Healing Is Associated With Improved Long-term Outcomes of Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis","volume":"14","author":"Shailja C Shah","year":"2016","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255620","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T13:32:43Z","timestamp":1628083963000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255620"}},"subtitle":[],"editor":[{"given":"Senthilnathan","family":"Palaniyandi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,8,4]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0255620","relation":{"has-review":[{"id-type":"doi","id":"10.32388\/4LCU3M","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,4]]}}}