Julajak Limsrivilai; Wai Keung Leung

doi:10.5217/ir.2025.00202

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Letter to the Editor IBD Response: Comments on “Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey”: Julajak Limsrivilai¹, Wai Keung Leung²; Intestinal Research 2025;23(4):567-568.
DOI: https://doi.org/10.5217/ir.2025.00202
Published online: October 28, 2025

¹Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand

²Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

Correspondence to Wai Keung Leung, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China. E-mail: waikleung@hku.hk

• Received: September 1, 2025 • Accepted: September 14, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

See the letter "Comments on “Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey”" on page 565.

We sincerely thank Nishida et al. [1] for their insightful responses to our article “Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey [2].” We appreciate their efforts to enrich regional understanding by sharing data from Japan, which was not included in our study. As they noted, the prioritization of long-term remission and mucosal healing in Japan, supported by robust public healthcare subsidies, highlights the critical difference that healthcare infrastructure and reimbursement systems could have on treatment goals. Our survey observed that affordability is a pivotal factor in decision-making in many Asian territories, whereas the Japanese experience underscores how reduced cost barriers may promote a more proactive, guideline-driven approach to disease management.

The comparison regarding dosing frequency is especially constructive. We concur that once-daily dosing improves adherence and is positively received where access to appropriate formulations exists. Economic and logistical constraints in other Asian territories may limit the real-world application of simplified regimens, but these differences invite future collaboration to improve access and optimize therapy. We are also grateful for their opinion on the monitoring strategies and for highlighting the observed differences between the 2 surveys. Notably, both studies identified endoscopy as an essential modality for disease monitoring. Furthermore, our results indicated that C-reactive protein and histologic activity did not significantly influence physicians’ decisions to modify treatment regimens. These findings aligned with the Japanese survey, where only 29%, 10%, and 17% of physicians considered serum inflammatory markers, fecal inflammatory markers, and histologic activity, when contemplating de-escalation of 5-ASA (5-aminosalicylic acid; also known as mesalamine) therapy.

Finally, Prof. Nishid’s study [1] provides comprehensive insights into the patterns of mesalamine de-escalation and elucidates the factors influencing decisions to reduce or discontinue medication. These findings constitute a valuable resource and are expected to inform future guideline recommendations regarding mesalamine exit strategies. We value the comparative insights provided and agree that expanding regional collaboration in sharing experiences, as exemplified here, are vital for optimizing ulcerative colitis management in Asia.

NOTES

Funding Source

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Data Availability Statement

Data sharing is not applicable as no new data were created or analyzed in this study.

Author Contributions

Writing - original draft: Limsrivilai J. Writing - review & editing: Leung WK. Approval of final manuscript: all authors.

REFERENCES

1. Nishida T, Amano T, Osugi N, Yoshihara T. Comments on “Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey”. Intest Res 2025;23:565–566.Article PubMed PMC PDF
2. Limsrivilai J, Lai AY, Li STH, et al. Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey. Intest Res 2025;23:117–128.PubMed PMC

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Response: Comments on “Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey”

Intest Res. 2025;23(4):567-568. Published online October 28, 2025

DOI: https://doi.org/10.5217/ir.2025.00202

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