Comparative effectiveness of azathioprine in Crohn's disease and ulcerative colitis: prospective, long-term, follow-up study of 394 patients.
BACKGROUND
The long-term efficiacy for thiopurinic drugs in Crohn's disease (CD), and particularly in ulcerative colitis (UC), has been insufficiently studied.


OBJECTIVE
To evaluate prospectively and compare the long-term effectiveness of azathioprine (AZA) in CD and UC.


METHODS
Three hundred and ninety-four AZA treated patients were included consecutively included. Truelove-modified index and CDAI were used to assess effectiveness. Hospitalizations and surgical procedures were recorded.


RESULTS
Two hundred and thirty-eight patients with CD and 156 with UC received AZA for a median of 38 months.


RESULTS
Partial response/remission was achieved in 34%/49% of CD patients and in 47%/42% of UC (nonstatistically significant differences). STEROID TREATMENT: Prior to AZA, 49% of CD patients were receiving steroids, whereas only 8% needed steroids after therapy (P < 0.001). Corresponding figures in UC patients were 39% vs. 9% (P < 0.001). HOSPITALIZATIONS: Prior to AZA, the rate of hospitalizations in CD was 0.190 per-patient-year, while after treatment, it decreased to 0.099 (P < 0.001). Corresponding hospitalization rates in UC were 0.108 vs. 0.038 (P < 0.001).


METHODS
The rate of surgery in CD prior/after AZA was 0.038/0.011 per-patient-year (P < 0.001). The number of surgical interventions in UC prior/after AZA treatment was 26/0 (the rate per-patient-year was 0.018/0) (P < 0.001).


CONCLUSIONS
Our results confirm the effectiveness of AZA in inflammatory bowel disease, not only in the short term but also in the long term, resulting in a steroid sparing effect and in both a reduction in the number of hospitalizations and surgical procedures. AZA is similarly effective for both CD and UC patients.
Gisbert
J P
JP
Gastroenterology Unit, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. gisbert@meditex.es
Niño
P
P
Cara
C
C
Rodrigo
L
L
D001379:Azathioprine / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D001379:Azathioprine