Thiopurine Monotherapy Effective In Ulcerative Colitis, Find
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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, researchers assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery.

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.

Key Findings:
-- 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.

-- This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC.

-- Thiopurine intolerance was associated with increased risk of surgery in UC; with a more modest impact on need for surgery in CD.

Significance of this study:
In re-evaluating their current role in inflammatory bowel disease management, this study suggests that thiopurine monotherapy is effective in maintaining long-term clinical remission in ulcerative colitis. In Crohn’s disease, however, thiopurines are less effective as monotherapy particularly where there is perianal involvement.