Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease: relapse and recapture rates, with predictive factors in 237 patients

Kennedy, N.A. et al. (2014) Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease: relapse and recapture rates, with predictive factors in 237 patients. Alimentary Pharmacology and Therapeutics, 40(11-12), pp. 1313-1323. (doi: 10.1111/apt.12980)

Abstract

Background: Thiopurines (azathioprine and mercaptopurine) remain integral to most medical strategies for maintaining remission in Crohn's disease (CD) and ulcerative colitis (UC). Indefinite use of these drugs is tempered by long-term risks. While clinical relapse is noted frequently following drug withdrawal, there are few published data on predictive factors.

Aim: To investigate the success of planned thiopurine withdrawal in patients in sustained clinical remission to identify rates and predictors of relapse.

Methods This was a multicentre retrospective cohort study from 11 centres across the UK. Patients included had a definitive diagnosis of IBD, continuous thiopurine use ≥3 years and withdrawal when in sustained clinical remission. All patients had a minimum of 12 months follow-up post drug withdrawal. Primary and secondary end points were relapse at 12 and 24 months respectively.

Results: 237 patients were included in the study (129 CD; 108 UC). Median duration of thiopurine use prior to withdrawal was 6.0 years (interquartile range 4.4–8.4). At follow-up, moderate/severe relapse was observed in 23% CD and 12% UC patients at 12 months, 39% CD and 26% UC at 24 months. Relapse rate at 12 months was significantly higher in CD than UC (P = 0.035). Elevated CRP at withdrawal was associated with higher relapse rates at 12 months for CD (P = 0.005), while an elevated white cell count was predictive at 12 months for UC (P = 0.007). Conclusion Thiopurine withdrawal in the context of sustained remission is associated with a 1-year moderate-to-severe relapse rate of 23% in Crohn's disease and 12% in ulcerative colitis.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gaya, Mr Daniel
• Authors: Kennedy, N.A., Kalla, R., Warner, B., Gambles, C.J., Musy, R., Reynolds, S., Dattani, R., Nayee, H., Felwick, R., Harris, R., Marriott, S., Senanayake, S.M., Lamb, C.A., Al-Hilou, H., Gaya, D.R., Irving, P.M., Mansfield, J., Parkes, M., Ahmad, T., Cummings, J.R.F., Arnott, I.D., Satsangi, J., Lobo, A.J., Smith, M., Lindsay, J.O., and Lees, C.W.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Alimentary Pharmacology and Therapeutics
• Publisher: John Wiley & Sons Ltd.
• ISSN: 0269-2813
• ISSN (Online): 1365-2036
• Copyright Holders: Copyright © 2014 The Authors
• First Published: First published in Alimentary Pharmacology and Therapeutics 40(11-12):1313-1323
• Publisher Policy: Reproduced under a Creative Commons License