Long-term effectiveness of azathioprine in IBD beyond 4 years: a European multicenter study in 1176 patients.
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.
Holtmann
Martin H
MH
First Department of Medicine, Johannes Gutenberg University, Mainz, Germany.
Krummenauer
Frank
F
Claas
Christina
C
Kremeyer
Kristina
K
Lorenz
Dirk
D
Rainer
Olivia
O
Vogel
Iris
I
Böcker
Ulrich
U
Böhm
Stephan
S
Büning
Carsten
C
Duchmann
Rainer
R
Gerken
Guido
G
Herfarth
Hans
H
Lügering
Norbert
N
Kruis
Wolfgang
W
Reinshagen
Max
M
Schmidt
Jan
J
Stallmach
Andreas
A
Stein
Jürgen
J
Sturm
Andreas
A
Galle
Peter R
PR
Hommes
Daan W
DW
D'Haens
Geert
G
Rutgeerts
Paul
P
Neurath
Markus F
MF
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
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine