The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Sulphasalazine and Prednisone Compared with Sulphasalazine for Treating Active Crohn Disease: A Double-Blind, Randomized, Multicenter Trial

Marno C. M. Rijk, MD; Ruud A. van Hogezand, MD, PhD; Henk J. J. van Lier, MSc; and Jan H. M. van Tongeren, MD, PhD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Marno C. M. Rijk, MD, Department of Internal Medicine, Ziekenhuis de Baronie, P.O. Box 90157, 4800 RL Breda, The Netherlands.

Current Author Addresses: Dr. Rijk: Department of Internal Medicine, Ziekenhuis de Baronie, P.O. Box 90157, 4800 RL Breda, The Netherlands.

Dr. van Tongeren: Department of Gastrointestinal and Liver Diseases, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

Dr. van Hogezand: Medisch Spectrum Twente, Haakbergerstraat 55, 7513 ER Enschede, The Netherlands.

Mr. van Lier: Medisch Statistische Adviesafdeling, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

From the University Hospital Nijmegen and the University of Nijmegen, Nijmegen, The Netherlands. For current author addresses, see end of text.*The multicenter group included: M.C.M. Rijk, R.A. van Hogezand, P.A.M. van Hees, J.H.M. van Tongeren, H.J.J, van Lier, and Ph. van Eiteren, Nijmegen; W.M.M. Driessen, A.A.M. Masclee, and CT. Postma, Eindhoven; J. Scherpenisse, H.A. Sonneveldt, and R.J.Th.M. Ypma, Enschede; P.H.E. Berghuis, Helmond; J.H.E. Custers, A. M. Smit, E.W. van der Hoek, 's-Hertogenbosch; O.J.J. Cluysenaer, Amersfoort; A.M. de Vlaam, Eindhoven; L.P. Bos and L.G.J.B. Engels, Stittard; G. Bëtius, Breda; and J. Ferwerda, Haarlem, The Netherlands.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(6):445-450. doi:10.7326/0003-4819-114-6-445
Text Size: A A A

Objective: To determine whether sulphasalazine plus prednisone is more effective than sulphasalazine alone in treating active Crohn disease.

Design: Randomized, double-blind, placebo-controlled trial.

Setting: Multicenter trial in one university hospital and nine general hospitals.

Patients: Patients with active Crohn disease and a Van Hees Activity Index of 140 or more. Of 71 patients who were randomly assigned, 60 completed treatment and were analyzed.

Interventions: For 16 weeks, 30 patients received sulphasalazine, 6 g/d (or 4 g/d if adverse effects occurred) and prednisone, 30 mg/d initially. Prednisone therapy was tapered in increments of 5 mg/2 wk to 10 mg/d after 8 weeks. Thirty other patients received sulphasalazine and a placebo.

Measurements and Main Results: In the first 6 weeks of treatment, the Van Hees Activity Index decreased to a median of 70% (interquartile range, 57% to 81%) of the initial value in patients treated with sulphasalazine and prednisone and to a median of 87% (interquartile range, 70% to 94%) in patients treated with sulphasalazine alone (P = 0.001). In the last 4 weeks of treatment, the corresponding figures were 63% (interquartile range, 40% to 75%) and 70% (interquartile range, 54% to 90%) (P = 0.10). The Crohn's Disease Activity Index decreased in the first 6 weeks to a median of 65% (interquartile range, 57% to 86%) in patients receiving sulphasalazine and prednisone and to a median of 75% (interquartile range, 58% to 101%) in patients receiving sulphasalazine alone (P = 0.13). In the last 4 weeks of treatment, the corresponding figures were 65% (interquartile range, 42% to 90%) and 76% (interquartile range, 49% to 110%) (P = 0.19).

Conclusions: The use of prednisone in addition to sulphasalazine in patients with active Crohn disease results in a significantly faster initial improvement, but not in a significantly better result after 16 weeks of treatment, when disease activity is measured by the Van Hees Activity Index.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.