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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

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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.

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Authors and Affiliations

  1. 1st 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. Department for Medical Biometrics, Epidemiology and Informatics, Johannes Gutenberg University, Mainz, Germany

    Frank Krummenauer

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

    Ulrich Böcker

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

    Stephan Böhm

  5. Department of Gastroenterology, Charite University of Berlin, Berlin, Germany

    Carsten Büning

  6. Medical Clinic I, University Medicine Berlin-Charite, Campus Benjamin Franklin, Berlin, Germany

    Rainer Duchmann

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

    Guido Gerken

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

    Hans Herfarth

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

    Norbert Lügering

  10. Department of Internal Medicine, Kalk Hospital, Cologne, Germany

    Wolfgang Kruis

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

    Max Reinshagen

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

    Jan Schmidt

  13. Department of Gastroenterology, University Hospital, Jena, Germany

    Andreas Stallmach

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

    Jürgen Stein

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

    Andreas Sturm

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

    Daan W. Hommes

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

    Geert D’Haens & Paul Rutgeerts

  18. 1st Department of Medicine, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Martin H. Holtmann

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  1. Martin H. Holtmann
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Correspondence to Martin H. Holtmann.

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Holtmann, M.H., Krummenauer, F., Claas, C. et al. 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. Dig Dis Sci 55, 1066–1078 (2010). https://doi.org/10.1007/s10620-009-0846-9

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