The impact of timing and duration of thiopurine treatment on colectomy in ulcerative colitis: a national population‐based study of incident cases between 1989–2009. Issue 1 (10th November 2014)

• Record Type: Journal Article
• Authors: Chhaya, V.; Saxena, S.; Cecil, E.; Chatu, S.; Subramanian, V.; Curcin, V.; Majeed, A.; Pollok, R. C.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 41:Issue 1(2015)
• Page Start: 87
• Page End: 98
• Publication Date: 2014-11-10
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13017
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13017-abs-0001"> <title>Summary</title> <sec id="apt13017-sec-0001" sec-type="section"> <title>Background</title> <p>The role of thiopurines in altering the risk of colectomy in ulcerative colitis (UC) remains unclear.</p> </sec> <sec id="apt13017-sec-0002" sec-type="section"> <title>Aims</title> <p>To examine predictors of colectomy in UC and determine the impact of thiopurines on the risk of colectomy.</p> </sec> <sec id="apt13017-sec-0003" sec-type="section"> <title>Methods</title> <p>We constructed a population‐based cohort of incident cases of UC in the United Kingdom between 1989 and 2009. We determined trends in thiopurine usage and colectomy for three defined cohorts: era 1 (1989–1995), era 2 (1996–2002), era 3 (2003–2009). We used Cox regression to determine predictors of colectomy and quantified the impact of duration and timing of thiopurine use on the risk of colectomy.</p> </sec> <sec id="apt13017-sec-0004" sec-type="section"> <title>Results</title> <p>We identified 8673 incident cases of UC. 5‐year colectomy rates increased from 4.2%, 5.1% to 6.9% (<italic>P</italic> = 0.001) for era 1, era 2 and era 3, respectively, despite increasing thiopurine use. This was not significant after adjustment for predictors of colectomy (<italic>P</italic> = 0.06). There was a higher risk of colectomy in men (HR 1.44, 95% CI: 1.19–1.73), those diagnosed at an early age (HR 1.35, 95% CI: 1.04–1.75; 16–24 vs. 25–64) and early steroid users (HR 1.94, 95% CI: 1.59–2.37). 5‐ASA users were less likely to require a colectomy (HR 0.35, 95% CI: 0.28–0.44). Amongst thiopurine users, those treated for greater than 12 months had a 71% reduction in risk of colectomy (HR 0.29, 95% CI: 0.21–0.40). Early thiopurines offered no additional benefit.</p> </sec> <sec id="apt13017-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Thiopurine exposure for greater than 12 months reduces the likelihood of colectomy by 71%. Young men and those requiring steroids within 3 months of diagnosis are at greatest risk of colectomy, and most likely to benefit from sustained thiopurine use.</p> </sec> </abstract>