title: Prognosis of Patients with Ulcerative Colitis in Sustained Remission After Thiopurines Withdrawal.
abstract: BACKGROUND
  The ideal length of treatment with thiopurines in patients with ulcerative colitis (UC) in sustained remission remains unknown. It is widely accepted that the drug withdrawal is associated with a worse outcome. The aim of this study was to analyze the outcome after this withdrawal and to identify predictors of relapse.
  
  
  METHODS
  A multicenter and retrospective study was designed. A total of 102 patients with UC who discontinued thiopurines in a situation of sustained remission were included. All the patients were followed up until last revision or until relapse (understood as the occurrence of signs and symptoms of UC that required a rescue treatment).
  
  
  RESULTS
  After thiopurines withdrawal, overall relapse was recorded in 32.35% of the patients: 18.88% in the first year, 36.48% in the third, and 43.04% in the fifth year after withdrawal. On multivariate analysis, predictors of relapse were the time from diagnosis of UC until the starting of thiopurines (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.01-1.02; P = 0.039), the number of relapses before the withdrawal (HR, 1.3; 95% CI, 1.01-1.66; P = 0.029), pancolitis (HR, 5.01; 95% CI, 1.95-26.43; P = 0.028), the duration of treatment with thiopurines (HR, 0.15; 95% CI, 0.03-0.66; P = 0.013) and the situation of biological remission at withdrawal (HR, 0.004; 95% CI, 0.0001-0.14; P = 0.002).
  
  
  CONCLUSIONS
  The withdrawal of thiopurines in patients with UC, although in sustained remission, is related to a high relapse rate. Clinical variables such as the extent of the disease, the duration of treatment or time from diagnosis to the start of thiopurines should be considered before stopping these drugs.
authors.affiliation: *Department of Gastroenterology, IMIBIC (Maimónides Institute of Biomedical Research of Córdoba), University Hospital Reina Sofía, Córdoba, Spain; †Department of Gastroenterology, University Hospital Juan Ramón Jiménez, Huelva, Spain; ‡Department of Gastroenterology, University Hospital Virgen del Rocío, Sevilla, Spain; §Department of Gastroenterology, University Hospital Virgen de las Nieves, Granada, Spain; ‖Department of Gastroenterology, University Hospital Nuestra Señora de Valme, Sevilla, Spain; ¶Department of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain; and **Department of Gastroenterology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Moreno-Rincón
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Benítez
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Serrano-Ruiz
authors.forename: Juan María
authors.initials: JM
authors.lastname: Vázquez-Morón
authors.forename: Héctor
authors.initials: H
authors.lastname: Pallarés-Manrique
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Herrera-Justiniano
authors.forename: Eduardo
authors.initials: E
authors.lastname: Leo-Carnerero
authors.forename: María Rosario
authors.initials: MR
authors.lastname: Gómez-García
authors.forename: María José
authors.initials: MJ
authors.lastname: Cabello-Tapia
authors.forename: Manuel
authors.initials: M
authors.lastname: Castro-Fernández
authors.forename: María
authors.initials: M
authors.lastname: Rojas-Feria
authors.forename: Luisa
authors.initials: L
authors.lastname: Castro-Laria
authors.forename: Federico
authors.initials: F
authors.lastname: Argüelles-Arias
authors.forename: Raquel
authors.initials: R
authors.lastname: Camargo-Camero
authors.forename: Guillermo
authors.initials: G
authors.lastname: Alcaín-Martínez
authors.forename: Eva
authors.initials: E
authors.lastname: Iglesias-Flores
authors.forename: Valle
authors.initials: V
authors.lastname: García-Sánchez
mesh_terms: D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy*; D003113:Colonoscopy; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine