Oral Mesalamine Use in Crohn's Disease After Implementation of the American College of Gastroenterology Guidelines: A TARGET-IBD Cohort Study.

Challenge

Following the March 2018 ACG guideline explicitly recommending against oral mesalamine for CD, it was unknown how quickly—or whether—this recommendation would change real-world prescribing patterns in US academic and community gastroenterology practices.

Solution

The TARGET-IBD registry was used to compare mesalamine use prevalence before and after the ACG guideline publication, identifying predictors of continued use and characterizing how the guideline affected prescribing in academic versus community settings.

Impact

Demonstrating that mesalamine use in CD remained essentially unchanged after the 2018 ACG guideline—with colonic and inflammatory phenotypes most likely to remain on therapy—documents a significant guideline adherence gap, providing the evidence base for targeted prescriber education and quality improvement initiatives.