Mesalazine for People with Diverticular Disease: A Systematic Review of Randomized Controlled Trials

Table 2

Summary of findings: mesalazine versus control interventions by subtype of diverticular disease.

Outcome	Subtype of diverticular disease	No. of participants (no. of studies)	Absolute effect (per 100 patients treated)	Relative effect (95 CI)	Certainty of the evidence (GRADE)	Conclusion
Achievement of disease remission	Symptomatic uncomplicated diverticular disease	123 (1)	3 more per 100; (95% CI: 14 fewer to 19 more)	1.04 (0.81 to 1.34)	Very Low; ●○○○	It is uncertain whether mesalazine may lead to no difference in the achievement of disease remission.
	Acute uncomplicated diverticulitis	81 (1)	20 more per 100; (95% CI: 3 fewer to 38 more)	2.67 (1.05 to 6.79)	Very Low; ●○○○	It is uncertain whether mesalazine may lead to the achievement of disease remission.
Disease recurrence	Symptomatic uncomplicated diverticular disease	216 (2)	13 fewer per 100; (95% CI: 23 to 2 fewer)	0.52 (0.28 to 0.97)	Low; ●●○○	Mesalazine may decrease disease recurrence.
	Acute uncomplicated diverticulitis	2196 (7)	3 fewer per 100; (95% CI: 12 fewer to 6 more)	0.90 (0.61 to 1.33)	Low; ●●○○	Mesalazine may lead to no difference in disease recurrence.
Acute diverticulitis onset in symptomatic uncomplicated diverticular disease	Symptomatic uncomplicated diverticular disease	484 (3)	3 fewer per 100; (95% CI: 7 fewer to 0)	0.26 (0.06 to 1.20)	Low; ●●○○	Mesalazine may lead to no difference in the development of acute diverticulitis in patients with symptomatic uncomplicated diverticular disease.
Need for surgery	Symptomatic uncomplicated diverticular disease	424 (2)	No effect per 100; (95% CI: 1 fewer to 1 more)	0.68 (0.03 to 16.39)	Very Low; ●○○○	It is uncertain whether mesalazine may lead to no difference in the need for surgery.
	Acute uncomplicated diverticulitis	1263 (3)	1 more per 100; (95% CI: 0 to 2 more)	1.41 (0.51 to 3.90)	Low; ●●○○	Mesalazine may lead to no difference in the need for surgery.
Any adverse events	Symptomatic uncomplicated diverticular disease	391 (2)	1 fewer per 100; (95% CI: 5 fewer to 3 more)	1.04 (0.55 to 1.98)	Low; ●●○○	Mesalazine may lead to no difference in any adverse events.
	Acute uncomplicated diverticulitis	2196 (7)	3 more per 100; (95% CI: 2 fewer to 7 more)	1.03 (0.96 to 1.11)	Moderate; ●●●○	Mesalazine probably results in no difference in any adverse events.
All-cause mortality	Symptomatic uncomplicated diverticular disease	607 (4)	No effect per 100; (95% CI: 1 fewer to 1 more)	No event in included studies	Very Low; ●○○○	It is uncertain whether mesalazine may lead to no difference in all-cause mortality.
	Acute uncomplicated diverticulitis	1512 (5)	No effect per 100; (95% CI: 1 fewer to 1 more)	0.52 (0.05 to 5.68)	Very Low; ●○○○	It is uncertain whether mesalazine may lead to no difference in all-cause mortality.
Diverticular disease related mortality	Symptomatic uncomplicated diverticular disease	607 (4)	No effect per 100; (95% CI: 1 fewer to 1 more)	No event in included studies	Very Low; ●○○○	It is uncertain whether mesalazine may lead to no difference in diverticular disease related mortality.
	Acute uncomplicated diverticulitis	1512 (5)	No effect per 100; (95% CI: 1 fewer to 1 more)	No event in included studies	Very Low; ●○○○	It is uncertain whether mesalazine may lead to no difference in diverticular disease related mortality.
Global symptoms	Symptomatic uncomplicated diverticular disease	326 (2)	Standardized mean difference: 1.01 lower; (95% CI: 1.51 to 0.52 lower)	-	Low; ●●○○	Mesalazine may improve the global symptoms score.
	Acute uncomplicated diverticulitis	153 (2)	Standardized mean difference: 0.56 lower; (95% CI: 0.88 to 0.24 lower)	-	Low; ●●○○	Mesalazine may slightly improve the global symptoms score.
Time to recurrence (days)	Symptomatic uncomplicated diverticular disease	- (-)	No studies	-	Absent	No studies were found that evaluated the impact of mesalazine on time to disease recurrence of disease.
	Acute uncomplicated diverticulitis	91 (3)	Average difference in days: 30 lower (95% CI: 55 to 5 lower)	-	Very Low; ●○○○	It is uncertain whether mesalazine may lead to a decrease in time to disease recurrence.

standardized mean difference was used because global symptoms were assessed using different scales across included studies: 0 to 33 [24], 0 to 36 [25], 0 to 60 [29], and 4 to 40 [28].