Optimized thiopurine therapy before withdrawal of anti-tumour necrosis factor-α in patients with Crohn's disease
| Autor: | Marianne Kiszka-Kanowitz, Sandra Bohn Thomsen, Anette Mertz Nielsen, Lise Lotte Gluud, Klaus Theede |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Necrosis Disease Gastroenterology 03 medical and health sciences Feces Young Adult 0302 clinical medicine Crohn Disease Gastrointestinal Agents Recurrence Internal medicine medicine Humans In patient 030212 general & internal medicine Young adult Thioguanine Crohn's disease Hepatology Thiopurine methyltransferase biology business.industry Mercaptopurine Tumor Necrosis Factor-alpha Adalimumab medicine.disease Faecal calprotectin Infliximab Withholding Treatment biology.protein 030211 gastroenterology & hepatology Female medicine.symptom Calprotectin business Leukocyte L1 Antigen Complex Immunosuppressive Agents |
| Zdroj: | European journal of gastroenterologyhepatology. 30(10) |
| ISSN: | 1473-5687 |
| Popis: | Objective Two meta-analyses have found that the risk of relapse in Crohn's disease (CD) was ~40 and 50% 1 and 2 years, respectively, after withdrawal of anti-tumour necrosis factor-α (anti-TNFα). The aim of this study was to evaluate relapse rates in CD when thiopurine therapy was optimized before anti-TNFα withdrawal. Patients and methods An observational study was conducted including patients with CD in remission with optimized thiopurine therapy before anti-TNFα withdrawal. We defined optimized thiopurine therapy as 6-thioguanine levels of at least 150 nmol/mmol haemoglobin (∼300 pmol×10 red blood cells) and clinical/biochemical remission as Harvey-Bradshaw Index of 5 or less and faecal calprotectin of 200 µg/g or less. Results We included 33 patients (median age: 31 years, 55% males, and median disease duration: 7 years) followed for a median of 36 months. A total of three (9%) patients relapsed during the first year and six patients (in total 27%) relapsed after 2 years. After 2 years, none of the additional patients relapsed. The disease duration and duration of anti-TNFα treatment and faecal calprotectin levels before inclusion did not predict relapse. Calprotectin levels of at least 180 after 1 year predicted relapse at year 2. Conclusion This study found that 73% of patients with CD maintained remission (>2 years) when thiopurine therapy was optimized before withdrawal of anti-TNFα. Additional prospective evidence is needed to confirm the findings. |
| Databáze: | OpenAIRE |
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