Sulfasalazine is commonly used to treat pediatric ulcerative colitis (UC). Sulfasalazine can be compounded into a suspension form which is beneficial for children with difficulty swallowing a pill. Despite being utilized for over 40 years, there is a lack of published data on the efficacy and safety of sulfasalazine suspension in children with UC. Recently, third-party payors have begun refusing to pay for sulfasalazine suspension due to lack of data.
In this retrospective study, we reviewed the electronic medical records of patients ages <18 years diagnosed with UC from June 1999-December 2019 at Boston Children's Hospital and treated with sulfasalazine suspension as a first-line agent. We obtained demographics, clinical and endoscopic data to measure outcomes at one year and long term.
Of 57 patients treated with sulfasalazine suspension, 52 (91%) had a follow-up and 26/52(50%) remained in steroid-free remission at one year. Two patients were switched to sulfasalazine tablets due to nonmedical reasons and eleven (21%) required rescue treatment (two Infliximab, one Tacrolimus, eight 6MP/Azathioprine) within a year. Three required colectomy within a year and five in long term. Four (8%) developed non-serious adverse reactions and switched to 5-Aminosalicylates (5-ASA) by one year. The median duration of long term follow up was 36 months (range,2- 205 months) with 28 requiring treatment escalation in long term.
Sulfasalazine suspension is a safe and effective treatment for UC in children with difficulty swallowing a pill. The one-year remission rate on this treatment is comparable to 5-ASA utilized in children.