title: Efficacy of Thiopurines in Biologic-Naive Japanese Patients With Crohn's Disease: A Single-Center Experience.
abstract: OBJECTIVE
  Early use of biologics in patients with Crohn's disease (CD) improves quality of life. However, the effects of the early use of immunomodulators on long-term outcomes remain unclear. This study aimed to evaluate the effects of immunomodulators in patients with CD.
  
  
  METHODS
  Between January 2004 and December 2011, 47 biologic-naive CD patients treated with thiopurines alone for remission maintenance were analyzed. The patients were classified into 2 groups depending on the presence or absence of digestive complications. We evaluated the efficacy of and predictive factors for thiopurine use for remission maintenance.
  
  
  RESULTS
  The cumulative relapse rates at 24 and 60 months were 13.7% and 35.4%, respectively. Regarding patient characteristics, there was a significant difference in patient history of surgery between the non-relapse and relapse groups (P=0.021). The cumulative relapse rate was lower in patients without a history of surgery than in those with such a history (27.2% and 52.9% at 60.0 months, respectively). Multivariate analysis suggested that the prevalence of stricturing and penetrating complications is an independent factor for relapse. The cumulative relapse rate in patients without a history of surgery was significantly lower in the non-stricturing and non-penetrating group than in the stricturing and penetrating group (11.8% at 85.0 months vs. 58.5% at 69.0 months; P=0.036).
  
  
  CONCLUSIONS
  Thiopurine use might be beneficial for the long-term maintenance of remission in biologic-naive Crohn's disease patients without digestive complications and a history of surgery.
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yoshino
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Minami
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Honzawa
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yorimitsu
authors.initials: Y
authors.lastname: Koshikawa
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. ; Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
authors.forename: Ali
authors.initials: A
authors.lastname: Madian
authors.affiliation: The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Toyonaga
authors.affiliation: Department of Gastroenterology & Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
keywords: Biologic-naive; Crohn disease; Thiopurine