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
Creators: name: Stournaras, Evangelos
name: Qian, Wendi
name: Pappas, Apostolos
name: Hong, You Yi
name: Shawky, Rasha
name: UK IBD BioResource Investigators
name: Raine, Tim
name: Parkes, Miles
name: UK IBD Bioresource Investigators
name: Ahmad, Tariq
name: Kennedy, Nick
name: Irving, Peter
name: Prescott, Natalie
name: Lees, Charlie
name: Mansfield, John
name: Lamb, Chris
name: Satsangi, Jack
name: Simmons, Alison
name: Hart, Alisa
name: Subramanian, Sreedhar
name: Probert, Chris
name: Shenderey, Richard
name: Gunasekera, Anton
name: Kok, Klaartje Bel
name: Javaid, Babur
name: Sinha, Leena
name: Singh, Salil
name: Preston, Cathryn
name: Jarvis, Mark
name: Penn, Ruth
name: Dhar, Anjan
name: Shenoy, Achuth
name: Phillis, Kath
name: Oglesby, Arabis
name: Tilbury, Jude
name: Scott, Glyn
name: Collum, Joseph
name: Carter, Martyn
name: Barbour, Jamie
name: Gordon, John
name: Ramage, John
name: Sivagi, Ganesh
name: Roberts, Phil
name: Bose, Monica
name: Sebastian, Shaji
name: Wilkins, Joy
name: Banim, Paul
name: Kent, Alexana
name: Verma, Ajay
name: Warren, Dawn
name: Wiles, Alan
name: Johnson, Matthew
name: Koss, Konrad
name: Oza, Chirag
name: Elamin, Khalid
name: Woods, Annette
name: Baburajan, Bijay
name: MacDonald, Chris
name: Theron, Byron
name: Tremelling, Mark
name: Shmueli, Udi
name: Bevan, Roisin
name: Limdi, Jimmy
name: Nair, Prakash
name: Vani, Deven
name: Lewis, Stephen
name: Baker-Moffat, Michelle
name: Moran, Gordon
name: McLaughlin, Simon
name: Silva, Aminda De
name: Beckly, John
name: Cole, Anew
name: Murray, Charles
name: Lobo, Alan
name: Smith, Melissa
name: Mathew, Sanju
name: Saunders, John
name: Steed, Helen
name: Brookes, Matthew
name: Loehry, Juliette
name: Rahman, Monira
name: Butterworth, Jeff
name: Muddu, Ajay
name: Clark, Katie
name: Selinger, Christian
name: Ramadas, Arvind
name: McLaughlin, John
name: Pollok, Richard
name: Rees, Colin
name: Panter, Simon
name: Hobday, David
name: Foley, Stephen
name: Patel, Vinod
name: Wesley, Emma
name: Gavin, Daniel
name: Edwards, Cathryn
name: Bloom, Stuart
name: Nwokolo, Chuka
name: DeCaestecker, John
name: Hanna, Mina
name: Davies, Albert
name: Hancock, Laura
name: Cummings, Fraser
name: Ramakrishnan, Subramaniam
name: Tindall, Theresa
name: Landy, Jonathan
name: Appleby, Richard
name: Sharpstone, Dan
name: Li, Andy
name: Keld, Richard
name: Mear, Lin
name: Philips, Anne
name: Willia, Horace
name: Ben Warner, Laura Hancock
name: Durai, Dharmaraj
name: Brinkworth, Elaine
name: Mahmood, Zahid
name: Cooney, Rachel
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Inflammatory bowel disease
1506
2312
azathioprine
6-mercaptopurine
crohn's disease
ulcerative colitis
tolerance

description: 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&lt;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&lt;0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p&lt;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.