Digestive Diseases and Sciences

, Volume 55, Issue 4, pp 1066–1078

Significant Differences Between Crohn’s Disease and Ulcerative Colitis Regarding the Impact of Body Mass Index and Initial Disease Activity on Responsiveness to Azathioprine: Results from a European Multicenter Study in 1,176 Patients

  • Martin H. Holtmann
  • Frank Krummenauer
  • Christina Claas
  • Kristina Kremeyer
  • Dirk Lorenz
  • Olivia Rainer
  • Iris Vogel
  • Ulrich Böcker
  • Stephan Böhm
  • Carsten Büning
  • Rainer Duchmann
  • Guido Gerken
  • Hans Herfarth
  • Norbert Lügering
  • Wolfgang Kruis
  • Max Reinshagen
  • Jan Schmidt
  • Andreas Stallmach
  • Jürgen Stein
  • Andreas Sturm
  • Peter R. Galle
  • Daan W. Hommes
  • Geert D’Haens
  • Paul Rutgeerts
  • Markus F. Neurath
Original Article

DOI: 10.1007/s10620-009-0846-9

Cite this article as:
Holtmann, M.H., Krummenauer, F., Claas, C. et al. Dig Dis Sci (2010) 55: 1066. doi:10.1007/s10620-009-0846-9

Abstract

In a survey comprising 1,176 patients with inflammatory bowel disease (IBD) we recently showed that azathioprine (AZA) beyond 4 years is beneficial in ulcerative colitis (UC) patients and in a subset of Crohn’s disease (CD) patients. Here, we show for the first time that azathioprine responsiveness depends on body mass index (BMI). The relationship is reciprocal in UC and CD, with a better outcome in UC patients with a BMI<25 and in CD patients with a BMI>25. These observations are particularly interesting considering the evolving concept of a relationship between fatty metabolism and immune regulation. Additionally, we show that CD patients, but not UC patients, respond better to AZA when it is started in clinical remission. This observation may support data favouring a “hit hard and early” regime in CD. Finally, we were able to demonstrate a decrease in the incidence of CD-related complications requiring surgery through treatment with AZA.

Keywords

Azathioprine Crohn's disease Ulcerative colitis Disease activity Body mass index 

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Martin H. Holtmann
    • 1
    • 18
  • Frank Krummenauer
    • 2
  • Christina Claas
    • 1
  • Kristina Kremeyer
    • 1
  • Dirk Lorenz
    • 1
  • Olivia Rainer
    • 1
  • Iris Vogel
    • 1
  • Ulrich Böcker
    • 3
  • Stephan Böhm
    • 4
  • Carsten Büning
    • 5
  • Rainer Duchmann
    • 6
  • Guido Gerken
    • 7
  • Hans Herfarth
    • 8
  • Norbert Lügering
    • 9
  • Wolfgang Kruis
    • 10
  • Max Reinshagen
    • 11
  • Jan Schmidt
    • 12
  • Andreas Stallmach
    • 13
  • Jürgen Stein
    • 14
  • Andreas Sturm
    • 15
  • Peter R. Galle
    • 1
  • Daan W. Hommes
    • 16
  • Geert D’Haens
    • 17
  • Paul Rutgeerts
    • 17
  • Markus F. Neurath
    • 1
  1. 1.1st Department of MedicineJohannes Gutenberg UniversityMainzGermany
  2. 2.Department for Medical Biometrics, Epidemiology and InformaticsJohannes Gutenberg UniversityMainzGermany
  3. 3.Department of Medicine IIUniversity HospitalMannheimGermany
  4. 4.Department of GastroenterologyUniversity Hospital, Philipps UniversityMarburgGermany
  5. 5.Department of GastroenterologyCharite University of BerlinBerlinGermany
  6. 6.Medical Clinic IUniversity Medicine Berlin-ChariteBerlinGermany
  7. 7.Department of GastroenterologyUniversity HospitalEssenGermany
  8. 8.Department of GastroenterologyUniversity HospitalRegensburgGermany
  9. 9.Department of GastroenterologyUniversity HospitalMuensterGermany
  10. 10.Department of Internal MedicineKalk HospitalCologneGermany
  11. 11.Department of GastroenterologyUniversity HospitalUlmGermany
  12. 12.Department of SurgeryUniversity HospitalHeidelbergGermany
  13. 13.Department of GastroenterologyUniversity HospitalJenaGermany
  14. 14.Department of GastroenterologyUniversity of FrankfurtFrankfurtGermany
  15. 15.Department of GastroenterologyVirchow Hospital, University of BerlinBerlinGermany
  16. 16.Department of GastroenterologyAcademic Medical CenterAmsterdamThe Netherlands
  17. 17.Department of GastroenterologyUniversity HospitalLeuvenBelgium
  18. 18.1st Department of MedicineUniversity of MainzMainzGermany

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