Azathioprine for maintenance of remission in Crohn's disease: benefits outweigh the risk of lymphoma.
OBJECTIVE
Azathioprine is a commonly used and effective treatment for maintenance of remission for patients with steroid-dependent Crohn's disease (CD). However, azathioprine therapy is associated with an increased risk of non-Hodgkin's lymphoma. The objective of this analysis was to determine the impact of azathioprine therapy on survival and quality-adjusted life expectancy after accounting for both the benefits of therapy and potential increased risk of lymphoma.


METHODS
A decision analysis using a Markov model depicting the natural history of alternative management strategies for maintenance of remission in patients with CD was performed.


RESULTS
In the base-case analysis, treatment of CD patients with a steroid-induced remission with azathioprine resulted in an average increase in life expectancy of 0.04 years and 0.05 quality-adjusted years. The incremental gain in life expectancy decreased with increasing patient age and increasing risk of lymphoma.


CONCLUSIONS
Therapy with azathioprine to preserve remission in patients with CD results in increased quality-adjusted life expectancy. This increase was greatest in young patients who have the lowest baseline risk of non-Hodgkin's lymphoma and who have the greatest life expectancy in the absence of a CD-related death.
Lewis
J D
JD
Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. jlewis@cceb.med.upenn.edu
Schwartz
J S
JS
Lichtenstein
G R
GR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage* / Q000009:adverse effects; D003424:Crohn Disease / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D008017:Life Expectancy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality*; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis
D007166:Immunosuppressive Agents; D001379:Azathioprine