Withdrawal of Azathioprine in Inflammatory Bowel Disease Patients Who Sustain Remission: New Risk Factors for Relapse
Por:
Iborra, M, Herreras, J, Bosca-Watts, M, Cortes, X, Trejo, G, Cerrillo, E, Hervas, D, Minguez, M, Beltran, B and Nos, P
Publicada:
1 jun 2019
Resumen:
BackgroundThe benefits of immunosuppressants for sustaining remission and preventing flares of IBD are well known. However, optimal timing for withdrawal has not been determined.AimsThe 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.MethodsThis was a multicenter observational study of patients with IBD in remission whose immunosuppressant had been withdrawn.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.ResultsNinety-five patients were included (35 UC and 60 CD). The mean duration of AZA treatment was 87 and 77months 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 5years 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introduction of AZA (CD), and late introduction of AZA (UC).ConclusionsAlmost half of the patients in whom AZA was withdrawn were in remission at 5years. The candidates for withdrawal could be better identified based on corticosteroid dependence, previous surgery, timing of initiation, and indication for AZA.
Filiaciones:
Iborra, M:
Hosp Univ & Politecn La Fe, Gastroenterol Dept, Digest Dis Unit, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
CIBERehd, Madrid, Spain
Herreras, J:
Hosp Univ & Politecn La Fe, Gastroenterol Dept, Digest Dis Unit, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
Bosca-Watts, M:
Univ Valencia, Univ Clin Hosp Valencia, Digest Dis Dept, IBD Unit, Valencia 46017, Spain
:
Hosp Sagunto, Internal Med Div, Gastroenterol Sect, Sagunto, Spain
Univ CEU Cardenal Herrera, Dept Med, Valencia, Spain
Trejo, G:
Univ Valencia, Univ Clin Hosp Valencia, Digest Dis Dept, IBD Unit, Valencia 46017, Spain
Cerrillo, E:
Hosp Univ & Politecn La Fe, Gastroenterol Dept, Digest Dis Unit, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
Hervas, D:
Inst Invest Sanitaria La Fe, Valencia 46026, Spain
Minguez, M:
Univ Valencia, Univ Clin Hosp Valencia, Digest Dis Dept, IBD Unit, Valencia 46017, Spain
Beltran, B:
Hosp Univ & Politecn La Fe, Gastroenterol Dept, Digest Dis Unit, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
CIBERehd, Madrid, Spain
Nos, P:
Hosp Univ & Politecn La Fe, Gastroenterol Dept, Digest Dis Unit, Avinguda de Fernando Abril Martorell 106, Valencia 46026, Spain
CIBERehd, Madrid, Spain
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