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Usefulness of Thiopurine Monotherapy for Crohn’s Disease in the Era of Biologics: A Long-Term Single-Center Experience

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Abstract

Background

Thiopurines are classically used in Crohn’s disease (CD). Treatment fails in a proportion of patients either due to adverse events (AE) or lack of efficacy. Increasing use of anti-TNFα biologic drugs may have had impact on thiopurines usage.

Aim

To evaluate the evolving use of azathioprine (AZA) monotherapy in the era of biologics.

Methods

The study retrospectively analyzed clinical records of all CD patients who started treatment with AZA monotherapy at our center since 1990. Dates of starting AZA and treatment failure (TF) were collected. We defined AZA TF if it was withdrawn due to lack of efficacy or AE, or biologics were added.

Results

A total of 383 patients were included: 46.5% were males and mean age was 31 (range 17–84) years. Median follow-up was 43 (range 0.2–289) months. Overall, 147 patients (38%) experienced TF. Median cumulative survival time of AZA was 126 (95% CI 105–147) months. Proportion of patients with AZA TF increased along time: 7 patients in 1990–1995 (4.7% of all TF); 8 in 1996–2000 (5.4%); 22 in 2001–2005(15%); 41 in 2006–2010 (28%); 69 in 2011–2014 (47%) (p = 0.04). 7%, 21%, 4%, 45%, and 33.3% of patients moved to biologics in each period, respectively (χ2 = 13.07; p < 0.05). Seventy-four patients (18.4%) stopped AZA due to AE, and 73(19%) due to lack of efficacy. Regarding AZA indication, prevention of postoperative recurrence obtained better results than steroid dependency (p = 0.001); perianal fistulizing CD predicted poorer outcomes (p = 0.002).

Conclusion

An important proportion of CD patients under AZA monotherapy experienced TF in our experience. Although AZA monotherapy remains useful for CD in the era of biologics, current clinical practice is shifting to anti-TNFα biologic drugs in an increasing proportion of patients.

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Authors and Affiliations

  1. IBD Unit, Digestive Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain

    Cristina Suárez Ferrer, Yago González-Lama, Irene González-Partida, Marta Calvo Moya, Isabel Vera Mendoza, Virginia Matallana Royo & Luis Abreu Garcia

  2. Internal Medicine Department, Principe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain

    Juan Arevalo Serrano

Authors
  1. Cristina Suárez Ferrer
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  2. Yago González-Lama
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  3. Irene González-Partida
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Correspondence to Luis Abreu Garcia.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Suárez Ferrer, C., González-Lama, Y., González-Partida, I. et al. Usefulness of Thiopurine Monotherapy for Crohn’s Disease in the Era of Biologics: A Long-Term Single-Center Experience. Dig Dis Sci 64, 875–879 (2019). https://doi.org/10.1007/s10620-018-5381-0

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  • DOI: https://doi.org/10.1007/s10620-018-5381-0

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