| Autor: |
Ranjan, Mukesh Kumar, Kumar, Peeyush, Vuyyuru, Sudheer Kumar, Kante, Bhaskar, Mundhra, Sandeep K, Golla, Rithvik, Virmani, Shubi, Sharma, Raju, Sahni, Peush, Das, Prasenjit, Kalaivani, Mani, Upadhyay, Ashish Datt, Makharia, Govind, Kedia, Saurabh, Ahuja, Vineet |
| Zdroj: |
Journal of Crohn's & Colitis; Feb2024, Vol. 18 Issue 2, p192-203, 12p |
| Abstrakt: |
Background and Aims Thiopurines are viable option for the treatment of inflammatory bowel disease [IBD] in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited. Method We performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis [UC] and Crohn's disease [CD]. Patients initiated on thiopurines early in the disease course [≤2 years] were compared with those started late [>2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up. Results A total of 988 [UC: 720, CD: 268] patients were included (male: 665 [60.8%], median age: 40 [32–51] years, median follow-up: 40 [19–81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC [81% and 80% vs 82% and 74%; p = 0.92] or CD [76% and 66% vs 72% and 51%, p = 0.32]. Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45–0.97; p = 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32–6.71; p = 0.008], steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26–5.68; p = 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27–0.80; p = 0.005] for CD were predictors of thiopurine effectiveness. Conclusion Thiopurines have sustained long-term effectiveness in both UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation. [ABSTRACT FROM AUTHOR] |
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