title: The use of thiopurines for the treatment of inflammatory bowel diseases in clinical practice.
abstract: BACKGROUND
  Thiopurines are the most commonly used immunomodulatory drugs in inflammatory bowel diseases.
  
  
  OBJECTIVE
  To evaluate the use, the therapeutic and safety profiles of thiopurines in a large sample of IBD patients.
  
  
  METHODS
  We reviewed 3641 case histories of IBD patients. Thiopurines were prescribed in 582 patients (16.0%); the analysis was performed on the 553 (267 ulcerative colitis, 286 Crohn's disease) with exhaustive clinical data.
  
  
  RESULTS
  The main indications for treatment were steroid-dependence (328/553, 59.3%) and steroid-resistance (113/553, 20.7%). Thiopurines were started when CD were younger than UC patients (p<0.001) but earlier from diagnosis in UC than in CD patients (p=0.003). Efficacy was defined as optimal (258/553, 46.6%), partial (108/553, 19.5%), absent (85/553, 15.4%) and not assessable (102/553, 18.4%). Efficacy was independent of disease type, location/extension or duration and age at starting. Side effects were observed in 151/553 (27.3%) patients, leading to drug discontinuation in 101 (18.3%). 15 out of the 130 (11.5%) patients who took thiopurines for more than 4 years relapsed, more frequently in CD than in UC (OR=3.67 95% C.I. 0.98-13.69; p=0.053).
  
  
  CONCLUSIONS
  Thiopurines confirm their clinical usefulness and acceptable safety profile in managing complicated IBD patients. The majority of patients treated for longer than 4 years maintain response. No clinical and demographic predictive factors for efficacy and side effects were identified.
authors.affiliation: IRCCS Policlinico Hospital, Mangiagalli and Regina Elena Foundation Milan, Italy. saibo@tiscali.it
authors.forename: S
authors.initials: S
authors.lastname: Saibeni
authors.forename: T
authors.initials: T
authors.lastname: Virgilio
authors.forename: R
authors.initials: R
authors.lastname: D'Incà
authors.forename: L
authors.initials: L
authors.lastname: Spina
authors.forename: A
authors.initials: A
authors.lastname: Bortoli
authors.forename: M
authors.initials: M
authors.lastname: Paccagnella
authors.forename: M
authors.initials: M
authors.lastname: Peli
authors.forename: R
authors.initials: R
authors.lastname: Sablich
authors.forename: G
authors.initials: G
authors.lastname: Meucci
authors.forename: E
authors.initials: E
authors.lastname: Colombo
authors.forename: G
authors.initials: G
authors.lastname: Benedetti
authors.forename: C M
authors.initials: CM
authors.lastname: Girelli
authors.forename: G
authors.initials: G
authors.lastname: Casella
authors.forename: G
authors.initials: G
authors.lastname: Grasso
authors.forename: R
authors.initials: R
authors.lastname: de Franchis
authors.forename: M
authors.initials: M
authors.lastname: Vecchi
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine