TY - JOUR

T1 - Optimized thiopurine therapy before withdrawal of anti-tumour necrosis factor-α in patients with Crohn's disease

AU - Bohn Thomsen, Sandra

AU - Kiszka-Kanowitz, Marianne

AU - Theede, Klaus

AU - Gluud, Lise Lotte

AU - Mertz Nielsen, Anette

PY - 2018

Y1 - 2018

N2 - 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 8 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.

AB - 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 8 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.

KW - 6-thioguanine

KW - Anti-tumour necrosis factor-α therapy

KW - azathioprine

KW - Crohn's disease

KW - inflammatory bowel disease

U2 - 10.1097/MEG.0000000000001194

DO - 10.1097/MEG.0000000000001194

M3 - Journal article

C2 - 29975242

AN - SCOPUS:85053867238

VL - 30

SP - 1155

EP - 1158

JO - European Journal of Gastroenterology and Hepatology, Supplement

JF - European Journal of Gastroenterology and Hepatology, Supplement

SN - 0954-691X

IS - 10

ER -