Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn's disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource. Issue 4 (1st October 2020)

• Record Type: Journal Article
• Authors: Stournaras, Evangelos; Qian, Wendi; Pappas, Apostolos; Hong, You Yi; Shawky, Rasha; Raine, Tim; Parkes, Miles
• Other Names: author non-byline.; Ahmad Tariq author non-byline.; Kennedy Nick author non-byline.; Irving Peter author non-byline.; Prescott Natalie author non-byline.; Lees Charlie author non-byline.; Mansfield John author non-byline.; Lamb Chris author non-byline.; Satsangi Jack author non-byline.; Simmons Alison author non-byline.; Hart Alisa author non-byline.; Subramanian Sreedhar author non-byline.; Probert Chris author non-byline.; Shenderey Richard author non-byline.; Gunasekera Anton author non-byline.; Kok Klaartje Bel author non-byline.; Javaid Babur author non-byline.; Sinha Leena author non-byline.; Singh Salil author non-byline.; Preston Cathryn author non-byline.; Jarvis Mark author non-byline.; Penn Ruth author non-byline.; Dhar Anjan author non-byline.; Shenoy Achuth author non-byline.; Phillis Kath author non-byline.; Oglesby Arabis author non-byline.; Tilbury Jude author non-byline.; Scott Glyn author non-byline.; Collum Joseph author non-byline.; Carter Martyn author non-byline.; Barbour Jamie author non-byline.; Gordon John author non-byline.; Ramage John author non-byline.; Sivagi Ganesh author non-byline.; Roberts Phil author non-byline.; Bose Monica author non-byline.; Sebastian Shaji author non-byline.; Wilkins Joy author non-byline.; Banim Paul author non-byline.; Kent Alexana author non-byline.; Verma Ajay author non-byline.; Warren Dawn author non-byline.; Wiles Alan author non-byline.; Johnson Matthew author non-byline.; Koss Konrad author non-byline.; Oza Chirag author non-byline.; Elamin Khalid author non-byline.; Woods Annette author non-byline.; Baburajan Bijay author non-byline.; MacDonald Chris author non-byline.; Theron Byron author non-byline.; Tremelling Mark author non-byline.; Shmueli Udi author non-byline.; Bevan Roisin author non-byline.; Limdi Jimmy author non-byline.; Nair Prakash author non-byline.; Vani Deven author non-byline.; Lewis Stephen author non-byline.; Baker-Moffat Michelle author non-byline.; Moran Gordon author non-byline.; McLaughlin Simon author non-byline.; Silva Aminda de author non-byline.; Beckly John author non-byline.; Cole Anew author non-byline.; Murray Charles author non-byline.; Lobo Alan author non-byline.; Smith Melissa author non-byline.; Mathew Sanju author non-byline.; Saunders John author non-byline.; Steed Helen author non-byline.; Brookes Matthew author non-byline.; Loehry Juliette author non-byline.; Rahman Monira author non-byline.; Butterworth Jeff author non-byline.; Muddu Ajay author non-byline.; Clark Katie author non-byline.; Selinger Christian author non-byline.; Ramadas Arvind author non-byline.; McLaughlin John author non-byline.; Pollok Richard author non-byline.; Rees Colin author non-byline.; Panter Simon author non-byline.; Hobday David author non-byline.; Foley Stephen author non-byline.; Patel Vinod author non-byline.; Wesley Emma author non-byline.; Gavin Daniel author non-byline.; Edwards Cathryn author non-byline.; Bloom Stuart author non-byline.; Nwokolo Chuka author non-byline.; deCaestecker John author non-byline.; Hanna Mina author non-byline.; Davies Albert author non-byline.; Hancock Laura author non-byline.; Cummings Fraser author non-byline.; Ramakrishnan Subramaniam author non-byline.; MacDonald Chris author non-byline.; Tindall Theresa author non-byline.; Landy Jonathan author non-byline.; Appleby Richard author non-byline.; Sharpstone Dan author non-byline.; Li Andy author non-byline.; Keld Richard author non-byline.; Mear Lin author non-byline.; Philips Anne author non-byline.; Willia Horace author non-byline.; Ben Warner Laura Hancock author non-byline.; Durai Dharmaraj author non-byline.; Brinkworth Elaine author non-byline.; Mahmood Zahid author non-byline.; Cooney Rachel author non-byline.;
• Is Part Of: Gut. Volume 70:Issue 4(2021)
• Page Start: 677
• Page End: 686
• Publication Date: 2020-10-01
• Subjects: azathioprine -- 6-mercaptopurine -- crohn's disease -- ulcerative colitis -- tolerance; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-320185
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Thiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn's disease (CD), including their impact on need for surgery. Design: Outcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines. Results: Using 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015). Conclusion: Thiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD.