title: Risk of colectomy in patients with ulcerative colitis under thiopurine treatment.
abstract: OBJECTIVE
  Little is known about the risk factors of colectomy in patients with ulcerative colitis (UC) under thiopurine treatment. The aim of the study was to determine the prevalence and the predictive risk factors of colectomy in an extensive cohort of patients with UC treated with thiopurines in Spain.
  
  
  METHODS
  Among 5753 UC patients, we identified those diagnosed between 1980 and 2009 and treated with azathioprine or mercaptopurine (AZA/MP). We analyzed the age at diagnosis, familial history of IBD, extraintestinal manifestations (EIMs), disease extent, smoking status and treatment requirements (AZA/MP, cyclosporine (CsA) or anti-TNFα). Colectomies for dysplasia or cancer were excluded. Survival analysis and Cox proportional hazard regression were performed. Results were reported as hazard ratios (HR) with 95% CI.
  
  
  RESULTS
  Among the 1334 cases included, 119 patients (8.9%) required colectomy after a median time of 26 months (IQR 12-42) after AZA/MP initiation. Independent predictors of colectomy were: Extensive UC (HR 1.7, 95% CI: 1.1-2.6), EIMs (HR 1.5, 95% CI: 1.0-2.4), need for antiTNFα (HR 2.3, 95% CI: 1.5-3.4) and need for CsA (HR 2.4, 95% CI: 1.6-3.7). Patients requiring early introduction of AZA/MP had an increased risk of colectomy with a HR of 4.9 (95% CI: 3.2-7.8) when AZA/MP started in the first 33 months after UC diagnosis.
  
  
  CONCLUSIONS
  Nearly one-tenth of patients with UC under thiopurines require colectomy. Extensive UC, EIMs, need for CsA or anti-TNFα ever and an early need for AZA/MP treatment were associated with a higher risk of colectomy. These risk factors of colectomy could help to stratify risk in further controlled studies in UC.
authors.affiliation: Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Department of Gastroenterology, Barcelona, Spain. Electronic address: alexcanasventura@yahoo.es.
authors.forename: Alex
authors.initials: A
authors.lastname: Cañas-Ventura
authors.affiliation: Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Department of Gastroenterology, Barcelona, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Márquez
authors.affiliation: Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ricart
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.affiliation: Digestive System Service, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain.
authors.forename: Valle
authors.initials: V
authors.lastname: García-Sanchez
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Marín-Jiménez
authors.affiliation: Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Moranta
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Clínico Universitario, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gomollón
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Servei de Malalties Digestives, Corporació Sanitària Universitaria Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.affiliation: Hospital de Cruces, Barakaldo, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Merino
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.affiliation: Hospital General Universitario de Elche, Elche, Spain.
authors.forename: Narcis
authors.initials: N
authors.lastname: Vázquez-Romero
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitari Mutua de Terrassa, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Esteve
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Iborra
authors.affiliation: Hospital General Universitari d'Alacant, Alicante, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Maribel
authors.initials: M
authors.lastname: Vera
authors.affiliation: Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Department of Gastroenterology, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
mesh_terms: D000328:Adult; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D015122:Mercaptopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011336:Probability; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; C488629:azathiopurine; D016572:Cyclosporine; D015122:Mercaptopurine
keywords: Colectomy; Inflammatory bowel diseases; Thiopurines; Ulcerative colitis