title: Long-term effectiveness of azathioprine in IBD beyond 4 years: a European multicenter study in 1176 patients.
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.
authors.affiliation: First Department of Medicine, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Holtmann
authors.forename: Frank
authors.initials: F
authors.lastname: Krummenauer
authors.forename: Christina
authors.initials: C
authors.lastname: Claas
authors.forename: Kristina
authors.initials: K
authors.lastname: Kremeyer
authors.forename: Dirk
authors.initials: D
authors.lastname: Lorenz
authors.forename: Olivia
authors.initials: O
authors.lastname: Rainer
authors.forename: Iris
authors.initials: I
authors.lastname: Vogel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Böcker
authors.forename: Stephan
authors.initials: S
authors.lastname: Böhm
authors.forename: Carsten
authors.initials: C
authors.lastname: Büning
authors.forename: Rainer
authors.initials: R
authors.lastname: Duchmann
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Hans
authors.initials: H
authors.lastname: Herfarth
authors.forename: Norbert
authors.initials: N
authors.lastname: Lügering
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kruis
authors.forename: Max
authors.initials: M
authors.lastname: Reinshagen
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
authors.forename: Jürgen
authors.initials: J
authors.lastname: Stein
authors.forename: Andreas
authors.initials: A
authors.lastname: Sturm
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Daan W
authors.initials: DW
authors.lastname: Hommes
authors.forename: Geert
authors.initials: G
authors.lastname: D'Haens
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016013:Likelihood Functions; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine