title: Significant differences between Crohn's disease and ulcerative colitis regarding the impact of body mass index and initial disease activity on responsiveness to azathioprine: results from a European multicenter study in 1,176 patients.
abstract: In a survey comprising 1,176 patients with inflammatory bowel disease (IBD) we recently showed that azathioprine (AZA) beyond 4 years is beneficial in ulcerative colitis (UC) patients and in a subset of Crohn's disease (CD) patients. Here, we show for the first time that azathioprine responsiveness depends on body mass index (BMI). The relationship is reciprocal in UC and CD, with a better outcome in UC patients with a BMI<25 and in CD patients with a BMI>25. These observations are particularly interesting considering the evolving concept of a relationship between fatty metabolism and immune regulation. Additionally, we show that CD patients, but not UC patients, respond better to AZA when it is started in clinical remission. This observation may support data favouring a "hit hard and early" regime in CD. Finally, we were able to demonstrate a decrease in the incidence of CD-related complications requiring surgery through treatment with AZA.
authors.affiliation: 1st Department of Medicine, Johannes Gutenberg University, Mainz, Germany. mholtman@mail.uni-mainz.de
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: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D015992:Body Mass Index; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005060:Europe; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine