Alex Cañas-Ventura1, Lucia Márquez2, Elena Ricart3, Eugeni Domènech4, Javier P Gisbert5, Valle García-Sanchez6, Ignacio Marín-Jiménez7, Francisco Rodriguez-Moranta8, Fernando Gomollón9, Xavier Calvet10, Olga Merino11, Esther Garcia-Planella12, Narcis Vázquez-Romero13, Maria Esteve14, Marisa Iborra15, Ana Gutiérrez16, Maribel Vera17, Montserrat Andreu2. 1. Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Department of Gastroenterology, Barcelona, Spain. Electronic address: alexcanasventura@yahoo.es. 2. Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Department of Gastroenterology, Barcelona, Spain. 3. Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain. 4. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 5. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain. 6. Digestive System Service, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain. 7. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain. 8. Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain. 9. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Clínico Universitario, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain. 10. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Servei de Malalties Digestives, Corporació Sanitària Universitaria Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain. 11. Hospital de Cruces, Barakaldo, Spain. 12. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 13. Hospital General Universitario de Elche, Elche, Spain. 14. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitari Mutua de Terrassa, Barcelona, Spain. 15. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBEREHD), Spain; Hospital Universitario La Fe, Valencia, Spain. 16. Hospital General Universitari d'Alacant, Alicante, Spain. 17. Hospital Universitario Puerta de Hierro, Madrid, Spain.
Abstract
BACKGROUND AND AIMS: Little is known about the risk factors of colectomy in patients with ulcerative colitis (UC) under thiopurine treatment. The aim of the study was to determine the prevalence and the predictive risk factors of colectomy in an extensive cohort of patients with UC treated with thiopurines in Spain. METHODS: Among 5753 UC patients, we identified those diagnosed between 1980 and 2009 and treated with azathioprine or mercaptopurine (AZA/MP). We analyzed the age at diagnosis, familial history of IBD, extraintestinal manifestations (EIMs), disease extent, smoking status and treatment requirements (AZA/MP, cyclosporine (CsA) or anti-TNFα). Colectomies for dysplasia or cancer were excluded. Survival analysis and Cox proportional hazard regression were performed. Results were reported as hazard ratios (HR) with 95% CI. RESULTS: Among the 1334 cases included, 119 patients (8.9%) required colectomy after a median time of 26 months (IQR 12-42) after AZA/MP initiation. Independent predictors of colectomy were: Extensive UC (HR 1.7, 95% CI: 1.1-2.6), EIMs (HR 1.5, 95% CI: 1.0-2.4), need for antiTNFα (HR 2.3, 95% CI: 1.5-3.4) and need for CsA (HR 2.4, 95% CI: 1.6-3.7). Patients requiring early introduction of AZA/MP had an increased risk of colectomy with a HR of 4.9 (95% CI: 3.2-7.8) when AZA/MP started in the first 33 months after UC diagnosis. CONCLUSIONS: Nearly one-tenth of patients with UC under thiopurines require colectomy. Extensive UC, EIMs, need for CsA or anti-TNFα ever and an early need for AZA/MP treatment were associated with a higher risk of colectomy. These risk factors of colectomy could help to stratify risk in further controlled studies in UC.
BACKGROUND AND AIMS: Little is known about the risk factors of colectomy in patients with ulcerative colitis (UC) under thiopurine treatment. The aim of the study was to determine the prevalence and the predictive risk factors of colectomy in an extensive cohort of patients with UC treated with thiopurines in Spain. METHODS: Among 5753 UC patients, we identified those diagnosed between 1980 and 2009 and treated with azathioprine or mercaptopurine (AZA/MP). We analyzed the age at diagnosis, familial history of IBD, extraintestinal manifestations (EIMs), disease extent, smoking status and treatment requirements (AZA/MP, cyclosporine (CsA) or anti-TNFα). Colectomies for dysplasia or cancer were excluded. Survival analysis and Cox proportional hazard regression were performed. Results were reported as hazard ratios (HR) with 95% CI. RESULTS: Among the 1334 cases included, 119 patients (8.9%) required colectomy after a median time of 26 months (IQR 12-42) after AZA/MP initiation. Independent predictors of colectomy were: Extensive UC (HR 1.7, 95% CI: 1.1-2.6), EIMs (HR 1.5, 95% CI: 1.0-2.4), need for antiTNFα (HR 2.3, 95% CI: 1.5-3.4) and need for CsA (HR 2.4, 95% CI: 1.6-3.7). Patients requiring early introduction of AZA/MP had an increased risk of colectomy with a HR of 4.9 (95% CI: 3.2-7.8) when AZA/MP started in the first 33 months after UC diagnosis. CONCLUSIONS: Nearly one-tenth of patients with UC under thiopurines require colectomy. Extensive UC, EIMs, need for CsA or anti-TNFα ever and an early need for AZA/MP treatment were associated with a higher risk of colectomy. These risk factors of colectomy could help to stratify risk in further controlled studies in UC.
Authors: Evangelos Stournaras; Wendi Qian; Tim Raine; Miles Parkes; Apostolos Pappas; You Yi Hong; Rasha Shawky Journal: Gut Date: 2020-10-01 Impact factor: 23.059