Digestive Diseases and Sciences

, Volume 51, Issue 9, pp 1516–1524

Long-Term Effectiveness of Azathioprine in IBD Beyond 4 Years: A European Multicenter Study in 1176 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 Paper

Abstract

In Crohn’s disease the optimal duration of azathioprine treatment is still controversial and for ulcerative colitis only limited data are available to support its efficacy. Charts of 1176 patients with IBD from 16 European centers were analyzed. Flare incidences and steroid dosages were assessed for the time before and during treatment and after discontinuation. Within the first 4 years, azathioprine suppressed flare incidence and steroid consumption in both diseases (P < 0.001). While in CD discontinuation after 3–4 years did not lead to reactivation, this was the case in UC. However, continuation beyond 4 years further improved clinical activity in CD and steroid requirement in both diseases (P < 0.001). Discontinuation of azathioprine may thus be considered after 3–4 years in CD patients in complete remission without steroid requirement. In all other CD patients and for UC patients in general, continuation seems beneficial. These results support a novel differential algorithm for long-term azathioprine therapy in IBD.

Keywords

Azathioprine Crohn’s disease Ulcerative colitis Long-term immunosuppression 

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

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

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