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.
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.
Holtmann
Martin H
MH
1st Department of Medicine, Johannes Gutenberg University, Mainz, Germany. mholtman@mail.uni-mainz.de
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
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
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine