Monotherapy with thiopurines in stricturing Crohn's disease: A real-life experience from low- and middle-income countries

被引:2
作者
Kante, Bhaskar [1 ]
Vuyyuru, Sudheer Kumar [1 ]
Kedia, Saurabh [1 ]
Sahu, Pabitra [1 ]
Kumar, Peeyush [1 ]
Ranjan, Mukesh Kumar [1 ]
Virmani, Shubi [1 ]
Sharma, Raju [2 ]
Madhusudhan, Kumble Seetharama [2 ]
Panwar, Rajesh [3 ]
Das, Prasenjit [4 ]
Makharia, Govind [1 ]
Ahuja, Vineet [1 ]
机构
[1] All India Inst Med Sci, Dept Gastroenterol, Room 3093,3rd Floor,Main Emergency Bldg, New Delhi 110029, India
[2] All India Inst Med Sci, Dept Radiol, New Delhi 110029, India
[3] All India Inst Med Sci, Dept Surg Gastroenterol, New Delhi 110029, India
[4] All India Inst Med Sci, Dept Histopathol, New Delhi 110029, India
关键词
Anti-TNFs; Azathioprine; Biologicals; Complicated Crohn's disease; Corticosteroids; Crohn's disease; Inflammatory bowel disease; Stricture; Surgery; Thiopurines; INFLAMMATORY-BOWEL-DISEASE; METHYLTRANSFERASE GENOTYPE; INDUCED LEUKOPENIA; AZATHIOPRINE; MANAGEMENT; EFFICACY; GUIDELINES; PREDICTORS; INFLIXIMAB; DIAGNOSIS;
D O I
10.1007/s12664-022-01258-z
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Stricturing Crohn's disease (CD) is difficult to manage medically with limited treatment options, anti-tumor necrosis factor (TNF) therapy being the first-line therapy. Although thiopurines are also recommended first-line treatment option for maintenance of remission in steroid-dependent CD, evidence on their use in stricturing CD is lacking. We evaluated the efficacy of azathioprine (AZA) in patients with stricturing CD. Methods In this retrospective cohort study (January 2005 to July 2020), patients with stricturing CD who were managed with AZA as a primary therapy for at least 6 months, and had a follow-up of at least 6 months after AZA initiation were included. Disease characteristics, complications, long-term response, and adverse events were noted. Results One hundred and fifteen patients were included (mean age 33.8 +/- 14 years, 67.8% males, median disease duration 98 months [IQR: 60-158], median follow-up duration 60 months [IQR: 50-96]). 46.1% (n=53) patients had significant anemia at presentation, and 73% (n=84) had isolated small bowel involvement. Median dose of AZA was 100 mg (equivalent to 1.5 mg/kg). Median therapy and follow-up duration (after AZA initiation) was 17 (IQR: 9-42) and 33 months (IQR 18-60), respectively. The cumulative probability of maintaining response without treatment failure at 1, 2, and 5 years was 73.1%, 40.7%, and 18.5%, respectively. Among patients with AZA failure, 15.6% received methotrexate, 13% received anti-TNFs, and 9.5% underwent surgery. Significant anemia (<10 g/dL) at presentation and steroid dependence predicted AZA failure. 31.3% patients experienced adverse events, commonest being leukopenia (n=29, 25.2%). Conclusion Azathioprine demonstrated good short-term and modest long-term response rates in patients with stricturing CD.
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收藏
页码:343 / 351
页数:9
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