BACKGROUND: The duration of use of azathioprine (Aza) and 6-mercaptopurine (6-MP) for maintaining remission for Crohn's disease is debatable. AIM: To examine whether Aza/6-MP can be safely withdrawn in patients with Crohn's disease who have been in remission. METHODS: The following databases were searched: MEDLINE (1950-September 2010), EMBASE (1980-September 2010), CINHAL (1981-September 2010), PubMed (1950-September 2010), and the Cochrane Central Register of Controlled Trials (CENTRAL). Randomised controlled and cohort studies comparing azathioprine continuation versus placebo or no treatment were eligible for inclusion. Primary outcomes were relapse rate after discontinuation of Aza/6-MP at 6, 12, and 18 months, and 5 and 10 years. RESULTS: Five studies, with 256 patients and 168 controls, met the inclusion criteria. Stopping azathioprine/6-MP was found to significantly increase the risk of relapse at 6, 12, and 18 months with pooled odds ratios of 0.22 (95% CI 0.09-0.53), 0.25 (95% CI 0.11-0.56), and 0.35 (95% CI 0.21-0.6), respectively. Two trials examined relapse rate at 5 years with pooled OR 0.53 (95% CI 0.13-2.21). No trials looking at relapse rates beyond 5 years were identified. CONCLUSIONS: There is a clear benefit of continuing Aza/6-MP for at least 18 months to maintain remission for Crohn's disease patients who established remission. There is not enough evidence to provide clear guidance on whether or not to continue Aza/6-MP treatment beyond 18 months. Well-designed randomised controlled trials addressing this issue are needed.
BACKGROUND: The duration of use of azathioprine (Aza) and 6-mercaptopurine (6-MP) for maintaining remission for Crohn's disease is debatable. AIM: To examine whether Aza/6-MP can be safely withdrawn in patients with Crohn's disease who have been in remission. METHODS: The following databases were searched: MEDLINE (1950-September 2010), EMBASE (1980-September 2010), CINHAL (1981-September 2010), PubMed (1950-September 2010), and the Cochrane Central Register of Controlled Trials (CENTRAL). Randomised controlled and cohort studies comparing azathioprine continuation versus placebo or no treatment were eligible for inclusion. Primary outcomes were relapse rate after discontinuation of Aza/6-MP at 6, 12, and 18 months, and 5 and 10 years. RESULTS: Five studies, with 256 patients and 168 controls, met the inclusion criteria. Stopping azathioprine/6-MP was found to significantly increase the risk of relapse at 6, 12, and 18 months with pooled odds ratios of 0.22 (95% CI 0.09-0.53), 0.25 (95% CI 0.11-0.56), and 0.35 (95% CI 0.21-0.6), respectively. Two trials examined relapse rate at 5 years with pooled OR 0.53 (95% CI 0.13-2.21). No trials looking at relapse rates beyond 5 years were identified. CONCLUSIONS: There is a clear benefit of continuing Aza/6-MP for at least 18 months to maintain remission for Crohn's diseasepatients who established remission. There is not enough evidence to provide clear guidance on whether or not to continue Aza/6-MP treatment beyond 18 months. Well-designed randomised controlled trials addressing this issue are needed.
Authors: Martin H Holtmann; Frank Krummenauer; Christina Claas; Kristina Kremeyer; Dirk Lorenz; Olivia Rainer; Iris Vogel; Ulrich Böcker; Stephan Böhm; Carsten Büning; Rainer Duchmann; Guido Gerken; Hans Herfarth; Norbert Lügering; Wolfgang Kruis; Max Reinshagen; Jan Schmidt; Andreas Stallmach; Jürgen Stein; Andreas Sturm; Peter R Galle; Daan W Hommes; Geert D'Haens; Paul Rutgeerts; Markus F Neurath Journal: Dig Dis Sci Date: 2006-08-22 Impact factor: 3.199
Authors: Charles N Bernstein; Michael Fried; J H Krabshuis; Henry Cohen; R Eliakim; Suleiman Fedail; Richard Gearry; K L Goh; Saheed Hamid; Aamir Ghafor Khan; A W LeMair; Qin Ouyang; J F Rey; Ajit Sood; Flavio Steinwurz; Ole O Thomsen; Alan Thomson; Gillian Watermeyer Journal: Inflamm Bowel Dis Date: 2010-01 Impact factor: 5.325
Authors: Y Bouhnik; M Lémann; J Y Mary; G Scemama; R Taï; C Matuchansky; R Modigliani; J C Rambaud Journal: Lancet Date: 1996-01-27 Impact factor: 79.321
Authors: M Vilien; J F Dahlerup; L K Munck; P Nørregaard; K Grønbaek; J Fallingborg Journal: Aliment Pharmacol Ther Date: 2004-06-01 Impact factor: 8.171
Authors: Balakrishnan S Ramakrishna; Govind K Makharia; Vineet Ahuja; Uday C Ghoshal; Venkataraman Jayanthi; Benjamin Perakath; Philip Abraham; Deepak K Bhasin; Shobna J Bhatia; Gourdas Choudhuri; Sunil Dadhich; Devendra Desai; Bhaba Dev Goswami; Sanjeev K Issar; Ajay K Jain; Rakesh Kochhar; Goundappa Loganathan; Sri Prakash Misra; C Ganesh Pai; Sujoy Pal; Mathew Philip; Anna Pulimood; Amarender S Puri; Gautam Ray; Shivaram P Singh; Ajit Sood; Venkatraman Subramanian Journal: Indian J Gastroenterol Date: 2015-03-14
Authors: Heimo H Wenzl; Christian Primas; Gottfried Novacek; Alexander Teml; Anna Öfferlbauer-Ernst; Christoph Högenauer; Harald Vogelsang; Wolfgang Petritsch; Walter Reinisch Journal: Dig Dis Sci Date: 2014-11-08 Impact factor: 3.199
Authors: Ray K Boyapati; Joana Torres; Carolina Palmela; Claire E Parker; Orli M Silverberg; Sonam D Upadhyaya; Tran M Nguyen; Jean-Frédéric Colombel Journal: Cochrane Database Syst Rev Date: 2018-05-12