In:
Journal of Crohn's and Colitis, Oxford University Press (OUP), ( 2023-08-16)
Abstract:
Thiopurines are viable option for the treatment of inflammatory bowel disease [IBD] in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited. Method We performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis [UC] and Crohn’s disease [CD] . Patients initiated on thiopurines early in the disease course [≤2 years] were compared with those started late [ & gt;2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up. Results A total of 988 [UC: 720, CD: 268] patients were included (male: 665 [60.8%] , median age: 40 [32–51] years, median follow-up: 40 [19–81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC [81% and 80% vs 82% and 74%; p = 0.92] or CD [76% and 66% vs 72% and 51%, p = 0.32] . Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45–0.97; p = 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32–6.71; p = 0.008] , steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26–5.68; p = 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27–0.80; p = 0.005] for CD were predictors of thiopurine effectiveness. Conclusion Thiopurines have sustained long-term effectiveness in both UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation.
Type of Medium:
Online Resource
ISSN:
1873-9946
,
1876-4479
DOI:
10.1093/ecco-jcc/jjad135
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2023
detail.hit.zdb_id:
2389631-0
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