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Background:-Maintenance treatment with 5-aminosalicylic-acid (5-ASA) is recommended in ulcerative colitis, but accurate estimates of discontinuation and adherence in adolescents transitioning to young adulthood are lacking. Aim:-We aimed to determine rates and risk factors for discontinuation and adherence to oral 5-aminosalicylic-acid in adolescents and young adults aged 10-24-years in their first-year following diagnosis of ulcerative colitis. Design and setting:-Observational cohort study using the UK Clinical Practice Research Datalink amongst adolescents and young adults (aged 10-24 years) diagnosed with ulcerative colitis between 1.1.1998-1.5.2016. Methods:-We calculated time to oral 5-aminosalicylic-acid discontinuation (days) and adherence rates (proportion of days covered) during the first year of treatment using Kaplan Meier survival analysis and built Cox regression models to estimate the impact of sociodemographic and health-related risk factors. Results:-Among 607 adolescents and young adults aged 10-24 years starting oral 5-aminosalicylic-acid maintenance treatment, a quarter discontinued after one month, and 69% within a year. Discontinuation was higher among those aged 18-24 years (74%) than younger groups (61%, 56%, in 10-14, and 15-17-years respectively). Adherence was lower among those young adults than adolescents (69% for ages 18-24 vs 80% ages 10-14 years). Residents in deprived versus affluent postcodes were more likely to discontinue treatment (adjusted hazard ratio:1.46,-95%-CI:1.10-1.92). Early corticosteroid use for an acute flare, lowered the likelihood of oral 5-aminosalicylic-acid discontinuation (aHR:0.68, 95%-CI:0.51-0.90). Conclusion:-The first year of starting long term therapies in adolescents and young adults diagnosed with ulcerative colitis is a critical window for active follow up of maintenance treatment, particularly 18-24-year-olds and those living in deprived postcodes.