title: Crohn's disease outcome in patients under azathioprine: a tertiary referral center experience.
abstract: OBJECTIVE
  Azathioprine is of major importance in the treatment of Crohn's disease; its efficacy has been showed in several works, but real-life data regarding its use is scarce. Our aim was to address the outcome of patients with Crohn's disease under azathioprine in the real-life setting.
  
  
  METHODS
  Crohn's disease patients followed at an Inflammatory Bowel Disease Outpatient Clinic under azathioprine were consecutively enrolled, being allocated in one of four groups. Two groups included patients on treatment with this drug, regarding its two major indications - prevention of post-operative recurrence and steroid-dependent disease; a third group included patients who needed infliximab in addition to azathioprine and a fourth group comprised patients who did not tolerate azathioprine.
  
  
  RESULTS
  A total of 221 patients were enrolled, 180 on azathioprine due to steroid-dependency (64 needing additional treatment with infliximab) and 41 for prevention of post-operative recurrence. Steroid-free remission was obtained in 48%. Immunosuppression decreased the number of hospitalized patients (64% vs 36%; p<0.001), but not the surgery rates per person per year. Azathioprine as a post-operative drug was effective in decreasing hospitalizations. The addition of infliximab decreased the number of patients hospitalized (p=0.009) and hospitalization rates per person per year (p<0.001), but had no effect in the surgery rates per person per year. Sixty patients (23%) experienced adverse effects with AZA, 39 requiring discontinuation of the drug.
  
  
  CONCLUSIONS
  In this real-life study, azathioprine had a long-term steroid sparing effect and reduced hospitalizations. Combination with infliximab reduced hospitalizations but did not decrease the surgery rate.
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; Institute for Molecular and Cell Biology, Porto, Portugal. Electronic address: fm@med.up.pt.
authors: Fernando
authors: F
authors: Magro
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal; Department of Biochemistry (U38-FCT), Faculty of Medicine, University of Porto, Portugal.
authors: João
authors: J
authors: Santos-Antunes
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal.
authors: Filipe
authors: F
authors: Vilas-Boas
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal.
authors: Eduardo
authors: E
authors: Rodrigues-Pinto
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal.
authors: Rosa
authors: R
authors: Coelho
authors: Centre for Research in Health Informatics Systems and Technologies (CINTESIS), Faculty of Medicine, University of Porto, Portugal.
authors: Orquídea Silva
authors: OS
authors: Ribeiro
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal.
authors: Susana
authors: S
authors: Lopes
authors: Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal.
authors: Guilherme
authors: G
authors: Macedo
mesh_terms: D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D011182:Postoperative Care; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D055502:Secondary Prevention; D013256:Steroids; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D013256:Steroids; D000069285:Infliximab; D001379:Azathioprine
keywords: Azathioprine; Crohn's disease; Real-life study