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

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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.

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Authors and Affiliations

  1. First Department of Medicine, Johannes Gutenberg University, Mainz, Germany

    Martin H. Holtmann, Christina Claas, Kristina Kremeyer, Dirk Lorenz, Olivia Rainer, Iris Vogel, Peter R. Galle & Markus F. Neurath

  2. I. Medical Clinic, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Markus F. Neurath

  3. Department for Medical Biometrics, Epidemiology and Informatics, Johannes Gutenberg University, Mainz, Germany

    Frank Krummenauer

  4. Department of Medicine II, University Hospital, Mannheim, Germany

    Ulrich Böcker

  5. Department of Gastroenterology, University Hospital, Philipps University, Marburg, Germany

    Stephan Böhm

  6. Department of Gastroenterology, Charite, Virchow Hospital, University of Berlin, Berlin, Germany

    Carsten Büning

  7. Medicle Clinic I, University of Medicine Berlin-Charite, Campus Benjamin Franklin Berlin, Berlin, Germany

    Rainer Duchmann

  8. Department of Gastroenterology, University Hospital, Essen, Germany

    Guido Gerken

  9. Department of Internal Medicine I, University Hospital, Regensburg, Germany

    Hans Herfarth

  10. Department of Gastroenterology, University Hospital, Muenster, Germany

    Norbert Lügering

  11. Department of Internal Medicine, Kalk-Hospital, Cologne, Germany

    Wolfgang Kruis

  12. Department of Gastroenterology, University Hospital, Ulm, Germany

    Max Reinshagen

  13. Department of Surgery, University Hospital, Heidelberg, Germany

    Jan Schmidt

  14. Department of Gastroenterology, University Hospital, Homburg, Germany

    Andreas Stallmach

  15. Department of Gastroenterology, University Frankfurt, Frankfurt, Germany

    Jürgen Stein

  16. Department of Gastroenterology, Virchow Hospital, University of Berlin, Berlin, Germany

    Andreas Sturm

  17. Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands

    Daan W. Hommes

  18. Department of Gastroenterology, University Hospital, Leuven, Belgium

    Geert D’Haens & Paul Rutgeerts

Authors
  1. Martin H. Holtmann
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  2. Frank Krummenauer
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  3. Christina Claas
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  4. Kristina Kremeyer
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  5. Dirk Lorenz
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  6. Olivia Rainer
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  7. Iris Vogel
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  8. Ulrich Böcker
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  9. Stephan Böhm
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  10. Carsten Büning
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  11. Rainer Duchmann
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  12. Guido Gerken
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  13. Hans Herfarth
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  14. Norbert Lügering
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  15. Wolfgang Kruis
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  16. Max Reinshagen
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  17. Jan Schmidt
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  18. Andreas Stallmach
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  19. Jürgen Stein
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  20. Andreas Sturm
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  21. Peter R. Galle
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  22. Daan W. Hommes
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  23. Geert D’Haens
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  24. Paul Rutgeerts
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  25. Markus F. Neurath
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Corresponding author

Correspondence to Markus F. Neurath.

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Holtmann, M.H., Krummenauer, F., Claas, C. et al. Long-Term Effectiveness of Azathioprine in IBD Beyond 4 Years: A European Multicenter Study in 1176 Patients. Dig Dis Sci 51, 1516–1524 (2006). https://doi.org/10.1007/s10620-005-9037-5

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  • DOI: https://doi.org/10.1007/s10620-005-9037-5

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