Marisa Iborra1,2, Julia Herreras3, Marta Maia Boscá-Watts4, Xavier Cortés5,6, Galo Trejo4, Elena Cerrillo3, David Hervás7, Miguel Mínguez4, Belén Beltrán8,9, Pilar Nos3,10. 1. Digestive Disease Unit, Gastroenterology Department, Hospital Universitari i Politecnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain. marisaiborra@hotmail.com. 2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. marisaiborra@hotmail.com. 3. Digestive Disease Unit, Gastroenterology Department, Hospital Universitari i Politecnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain. 4. IBD Unit, Digestive Disease Department of the University Clinic Hospital of Valencia, University of Valencia, 46017, Valencia, Spain. 5. Gastroenterology Section, Internal Medicine Division, Hospital de Sagunto, Sagunto, Spain. 6. Departamento de Medicina, Universidad CEU Cardenal Herrera, Valencia, Spain. 7. Instituto de Investigación Sanitaria La Fe, 46026, Valencia, Spain. 8. Digestive Disease Unit, Gastroenterology Department, Hospital Universitari i Politecnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain. belenbeltranniclos@gmail.com. 9. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. belenbeltranniclos@gmail.com. 10. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
Abstract
BACKGROUND: The benefits of immunosuppressants for sustaining remission and preventing flares of IBD are well known. However, optimal timing for withdrawal has not been determined. AIMS: The objective of this study was to calculate the risk of relapse and predictors after withdrawal of azathioprine (AZA) monotherapy in patients who sustain deep remission. METHODS: This was a multicenter observational study of patients with IBD in remission whose immunosuppressant had been withdrawn. We recorded demographic variables, disease data, laboratory values, and the results of imaging tests performed at withdrawal and, in patients who relapsed, time to relapse and the efficacy of reintroducing the drug. RESULTS: Ninety-five patients were included (35 UC and 60 CD). The mean duration of AZA treatment was 87 and 77 months for UC and CD, respectively. Endoscopic remission was evaluated in 23 patients with UC and 35 with CD. After AZA withdrawal, 91% patients with UC and 67% with CD received high doses of salicylates. A total of 26 patients relapsed. The cumulative relapse rate at 5 years was 46% for CD and UC. AZA was reintroduced in 19 patients, of whom 14 responded. Predictors of relapse were corticosteroid dependence, early introduction of AZA (CD), and late introduction of AZA (UC). CONCLUSIONS: Almost half of the patients in whom AZA was withdrawn were in remission at 5 years. The candidates for withdrawal could be better identified based on corticosteroid dependence, previous surgery, timing of initiation, and indication for AZA.
BACKGROUND: The benefits of immunosuppressants for sustaining remission and preventing flares of IBD are well known. However, optimal timing for withdrawal has not been determined. AIMS: The objective of this study was to calculate the risk of relapse and predictors after withdrawal of azathioprine (AZA) monotherapy in patients who sustain deep remission. METHODS: This was a multicenter observational study of patients with IBD in remission whose immunosuppressant had been withdrawn. We recorded demographic variables, disease data, laboratory values, and the results of imaging tests performed at withdrawal and, in patients who relapsed, time to relapse and the efficacy of reintroducing the drug. RESULTS: Ninety-five patients were included (35 UC and 60 CD). The mean duration of AZA treatment was 87 and 77 months for UC and CD, respectively. Endoscopic remission was evaluated in 23 patients with UC and 35 with CD. After AZA withdrawal, 91% patients with UC and 67% with CD received high doses of salicylates. A total of 26 patients relapsed. The cumulative relapse rate at 5 years was 46% for CD and UC. AZA was reintroduced in 19 patients, of whom 14 responded. Predictors of relapse were corticosteroid dependence, early introduction of AZA (CD), and late introduction of AZA (UC). CONCLUSIONS: Almost half of the patients in whom AZA was withdrawn were in remission at 5 years. The candidates for withdrawal could be better identified based on corticosteroid dependence, previous surgery, timing of initiation, and indication for AZA.
Authors: Miguel Regueiro; Wolfgang Schraut; Leonard Baidoo; Kevin E Kip; Antonia R Sepulveda; Marilyn Pesci; Janet Harrison; Scott E Plevy Journal: Gastroenterology Date: 2008-10-31 Impact factor: 22.682
Authors: Estefanía Moreno-Rincón; José Manuel Benítez; Francisco Javier Serrano-Ruiz; Juan María Vázquez-Morón; Héctor Pallarés-Manrique; José Manuel Herrera-Justiniano; Eduardo Leo-Carnerero; María Rosario Gómez-García; María José Cabello-Tapia; Manuel Castro-Fernández; María Rojas-Feria; Luisa Castro-Laria; Federico Argüelles-Arias; Raquel Camargo-Camero; Guillermo Alcaín-Martínez; Eva Iglesias-Flores; Valle García-Sánchez Journal: Inflamm Bowel Dis Date: 2015-07 Impact factor: 5.325
Authors: David S Kotlyar; Mark T Osterman; Robert H Diamond; David Porter; Wojciech C Blonski; Mariusz Wasik; Sami Sampat; Manuel Mendizabal; Ming V Lin; Gary R Lichtenstein Journal: Clin Gastroenterol Hepatol Date: 2010-10-01 Impact factor: 11.382
Authors: N A Kennedy; R Kalla; B Warner; C J Gambles; R Musy; S Reynolds; R Dattani; H Nayee; R Felwick; R Harris; S Marriott; S M Senanayake; C A Lamb; H Al-Hilou; D R Gaya; P M Irving; J Mansfield; M Parkes; T Ahmad; J R F Cummings; I D Arnott; J Satsangi; A J Lobo; M Smith; J O Lindsay; C W Lees Journal: Aliment Pharmacol Ther Date: 2014-10-06 Impact factor: 8.171