Predictive factors associated with immunosuppressive agent use in ulcerative colitis: a case-control study.
BACKGROUND
Some patients with ulcerative colitis (UC) require immunosuppressants as maintenance therapy.


OBJECTIVE
To assess epidemiological, clinical and disease factors at diagnosis that predict immunosuppressant use in UC.


METHODS
All UC patients diagnosed between 1992 and 2005 and currently managed in the inflammatory bowel disease (IBD) clinic were included. Forty-three patients who currently or previously received azathioprine (AZA) or mercaptopurine (MP) for UC were compared with 130 controls. Charts were reviewed and logistic regression analyses were applied to identify factors associated with AZA or MP use.


RESULTS
In univariate model, seven factors at diagnosis correlated with AZA use: male gender [odds ratio (OR) 2.2]; left-sided or extensive colitis or pancolitis (OR 8.7-14.1); systemic steroid use within the first 6 months of diagnosis (OR 5.1); more than 10 bowel movements daily (OR 6.4); persistent or mostly blood in stool (OR 2.8); endoscopic proven moderate to severe disease (OR 7.2-12.0) and requirement of hospitalization (OR 2.7) on diagnosis. In multivariate model, the first three factors were shown to be statistically significant.


CONCLUSIONS
Male gender, initial presentation with severe and extensive disease clinically and endoscopically, requirement of hospitalization on diagnosis or systemic steroids within 6 months of diagnosis are predictive factors for immunosuppressant use in UC.
Division of Gastroenterology, The University of Western Ontario, London, ON, Canada. agathalau1@gmail.com
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Lau
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Chande
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Ponich
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Gregor
D000328:Adult; D000963:Antimetabolites / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use*; D016022:Case-Control Studies; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
D000963:Antimetabolites; D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine