Addition of thiopurines can recapture response in patients with Crohn's disease who have lost response to anti‐tumor necrosis factor monotherapy. Issue 10 (23rd September 2013)

• Record Type: Journal Article
• Authors: Ong, David E H; Kamm, Michael A; Hartono, Juanda Leo; Lust, Mark
• Is Part Of: Journal of gastroenterology and hepatology. Volume 28:Issue 10(2013:Oct.)
• Page Start: 1595
• Page End: 1599
• Publication Date: 2013-09-23
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.12263
• Languages: English
• ISSNs: 0815-9319

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jgh12263-sec-0001" sec-type="section"> <title>Background and Aim</title> <p>Anti‐tumor necrosis factor (TNF) antibodies are effective in maintaining remission in Crohn's disease. However, a significant proportion of patients lose response to these agents with time. This study aimed to determine whether the introduction of a thiopurine in patients who have lost response to anti‐TNF monotherapy results in regained response.</p> </sec> <sec id="jgh12263-sec-0002" sec-type="section"> <title>Methods</title> <p>Five patients (four males; aged 22–38 years) with active Crohn's disease, who had an initial response to anti‐TNF therapy but had lost response, were commenced on azathioprine or mercaptopurine at standard doses while continuing anti‐TNF therapy. All had previously failed thiopurine therapy prior to starting anti‐TNF treatment.</p> </sec> <sec id="jgh12263-sec-0003" sec-type="section"> <title>Results</title> <p>All patients experienced improved clinical symptoms within 2–6 months, with benefit sustained over a mean follow‐up of 19 months. Two patients with an elevated C‐reactive protein at the time of thiopurine addition demonstrated a fall in C‐reactive protein. Colonoscopy before and after thiopurine addition in four patients showed improvement in all, with mucosal healing achieved in two. No adverse effects of treatment were noted.</p> </sec> <sec id="jgh12263-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Addition of a thiopurine in patients who have lost response to anti‐TNF monotherapy is an effective strategy to recapture response even if the patient has previously failed thiopurine therapy. Thiopurines may reduce immunogenicity or act synergistically with anti‐TNF therapy.</p> </sec> </abstract>