title: Outcome following thiopurine use in children with ulcerative colitis: a prospective multicenter registry study.
abstract: OBJECTIVE
  Despite little supporting data, thiopurine use is common in pediatric ulcerative colitis (UC). Our aim was to determine outcome following thiopurine use in a multicenter inception cohort of children diagnosed with UC.
  
  
  METHODS
  Data were obtained from a prospective observational study of newly diagnosed children <16 years of age. Data are recorded at diagnosis, 30 days, and quarterly. Patients are managed by physician dictates not protocol. Disease activity is classified by physician global assessment. The primary outcome was corticosteroid (CS)-free inactive UC at 1 year following thiopurine initiation without the need for rescue therapy (infliximab, calcineurin inhibitors, or colectomy).
  
  
  RESULTS
  Of 1,490 patients in our registry, 394 have UC (mean age at diagnosis 11.3±3.7 years); 197 (50%) received thiopurine (49% ≤3 months from diagnosis). Also, 84% were receiving CSs and 60% 5-aminosalicylates at thiopurine start. Of the 197 patients, there was insufficient follow-up (41), previous or concomitant use of infliximab (16), or calcineurin inhibitor (7), leaving 133 patients evaluable at 1 year. Of these, 65 (49%) had CS-free inactive UC without rescue therapy. CS-free inactive disease at 1 year after initiating thiopurine was not affected by starting thiopurine ≤3 months vs. >3 months from diagnosis, gender, age, or concomitant treatment with 5-aminosalicylates. Kaplan-Meier analysis showed that the likelihood of remaining free of rescue therapy in the thiopurine-treated patients was 73% at 1 year.
  
  
  CONCLUSIONS
  Approximately 50% of children with UC starting thiopurine without previous or concomitant biologic or calcineurin inhibitor therapy have CS-free inactive disease 1 year later without the need for rescue therapy.
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA. jhyams@ccmckids.org
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hyams
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Michael
authors.initials: M
authors.lastname: Stephens
authors.forename: Marsha
authors.initials: M
authors.lastname: Kay
authors.forename: David
authors.initials: D
authors.lastname: Keljo
authors.forename: Marian
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: Shehzad
authors.initials: S
authors.lastname: Saeed
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
authors.forename: Sonia
authors.initials: S
authors.lastname: Michail
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Andrew
authors.initials: A
authors.lastname: Grossman
authors.forename: Charles
authors.initials: C
authors.lastname: Samson
authors.forename: Boris
authors.initials: B
authors.lastname: Sudel
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Neal
authors.initials: N
authors.lastname: Leleiko
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D019804:Mesalamine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D019804:Mesalamine; D015122:Mercaptopurine; D001379:Azathioprine