Adding Thiopurine After Loss of Response to Infliximab Versus Early Combination in Treating Crohn’s Disease: A Retrospective Study
| Autor: | Yuichi Matsuno, Tomohiko Moriyama, Takehiro Torisu, Keisuke Kawasaki, Motohiro Esaki, Takanari Kitazono, Yuta Fuyuno, Atsushi Hirano, Keizo Zeze, Shin Fujioka, Junji Umeno |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Drug-Related Side Effects and Adverse Reactions Combination therapy Antimetabolites Physiology Risk Assessment Gastroenterology 03 medical and health sciences 0302 clinical medicine Crohn Disease Japan Internal medicine Azathioprine medicine Humans Adverse effect Retrospective Studies Biological Products Crohn's disease Thiopurine methyltransferase biology Mercaptopurine business.industry Incidence (epidemiology) Drug Synergism Retrospective cohort study Hepatology medicine.disease Infliximab Treatment Outcome 030220 oncology & carcinogenesis biology.protein Drug Therapy Combination Female 030211 gastroenterology & hepatology Drug Monitoring business medicine.drug |
| Zdroj: | Digestive Diseases and Sciences. 66:3124-3131 |
| ISSN: | 1573-2568 0163-2116 |
| Popis: | Although combining thiopurine with infliximab (IFX) is considered to improve the clinical efficacy of IFX when treating Crohn’s disease (CD), it also increases the risk of adverse events (AEs). We compared the efficacy and safety of delayed thiopurine addition after loss of response (LOR) to IFX with the efficacy and safety of an earlier combination of thiopurine and IFX. This retrospective study analyzed patients with CD who started IFX as a first-line biologic at Kyushu University Hospital between June 2002 and July 2018. Patients were assigned to either the early-combination (EC) group, who started IFX and thiopurine simultaneously, or the late-combination (LC) group, who were treated with IFX alone until they developed LOR. We compared the cumulative IFX continuation rates and AE incidence between the two groups. One hundred seventy-six patients were enrolled in this study; 49 were enrolled in the EC group, and 127 were enrolled in the LC group. Disease activity at baseline did not significantly differ between the groups, nor did the cumulative IFX continuation rates differ between the groups (P = 0.30); however, the AE rate was significantly higher in the EC group than in the LC group (38.7% vs. 21.2%; P = 0.02). The severe AE rate was also higher in the EC group than in the LC group (18.3% vs 3.1%; P = 0.001). Considering the risk–benefit balance, delayed addition of thiopurine after LOR to IFX might be an alternative strategy when using IFX to treat CD. |
| Databáze: | OpenAIRE |
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