Takeaway
- Thiopurine monotherapy is an effective long-term treatment for ulcerative colitis (UC), but significantly less effective in Crohn’s disease (CD), particularly where there is perianal involvement.
Why this matters
- Given recent substantial reductions in the cost of biosimilars and the evidence presented regarding the relative lack of durable effectiveness of thiopurine monotherapy in CD, there is perhaps a need to re-evaluate treatment strategy of using thiopurines as maintenance for patients with CD.
Study design
- A retrospective analysis of long-term outcomes of thiopurine monotherapy for 11,928 patients with inflammatory bowel disease (IBD) (UC, n=4968; CD, n=6960) in the UK IBD BioResource (68,132 patient-years of exposure).
- Funding: None disclosed.
Key results
- Thiopurine monotherapy was effective for the duration of treatment in 2617/4968 (52.7%) patients with UC vs 2378/6960 (34.2%) patients with CD (P<.0001).
- Multivariable logistic regression analysis demonstrated that thiopurine monotherapy was less effective in CD than UC (OR, 0.47; 95% CI, 0.43-0.51; P<.0001) after adjusting for variables including treatment era.
- For CD, treatment initiation ≤1 year after IBD diagnosis (OR, 0.69; 95% CI, 0.60-0.78; P<.0001) and perianal disease (OR, 0.70; 95% CI, 0.61-0.80; P<.0001) correlated with lower thiopurine effectiveness.
- For UC, proctitis was associated with higher effectiveness (OR,1.56 vs extensive disease; 95% CI, 1.23-1.98; P=.0002).
- On Kaplan-Meier analysis, median duration on thiopurines in those in whom they were effective was 16 years for CD and 17 years for UC.
- Inability to tolerate thiopurines was associated with an increased risk of surgery in UC (HR, 2.44; 95% CI, 1.71-3.50; P<.0001), with a more modest effect in CD (HR, 1.23; 95% CI, 1.08-1.40; P=.0015).
Limitations
- Retrospective design.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
