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Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn's disease: long-term outcomes for 11928 patients in the UK inflammatory bowel disease bioresource
Stournaras, Evangelos Qian, Wendi Pappas, Apostolos Hong, You Yi Shawky, Rasha UK IBD BioResource Investigators Raine, Tim Parkes, Miles
Stournaras, Evangelos
Qian, Wendi
Pappas, Apostolos
Hong, You Yi
Shawky, Rasha
UK IBD BioResource Investigators
Raine, Tim
Parkes, Miles
Editors
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Epub Date
Issue Date
2020-10-01
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Abstract
Objective Thiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery. Design Outcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines. Results Using 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015). Conclusion Thiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD.
Citation
Stournaras E, Qian W, Pappas A, et al. (2020) Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn’s disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource. Gut 2021, 70:677-686.
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Research Unit
PubMed ID
33004550 (pubmed)
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Journal article
Language
en
Description
© 2020 The Authors. Published by BMJ. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: http://dx.doi.org/10.1136/gutjnl-2019-320185
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ISSN
0017-5749
EISSN
1468-3288
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Sponsors
The IBD BioResource is co-funded by the Medical Research Council (Grant number MR/M00533X/1), the Wellcome Sanger Institute, Open Targets, Crohn’s and Colitis UK (Grant number M14/1), National Institute for Health Research (NIHR, Grant/Portfolio number 20664) and the Cambridge Biomedical Research Centre (BRC). The Cambridge BRC is a partnership between Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, and is funded by the NIHR.
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Licence for published version: Creative Commons Attribution 4.0 International