Thiopurines Have Sustained Long-term Effectiveness in Patients with Inflammatory Bowel Disease, Which is Independent of Disease Duration at Initiation: A Propensity Score Matched Analysis.

IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Crohns & Colitis Pub Date : 2024-02-26 DOI:10.1093/ecco-jcc/jjad135
Mukesh Kumar Ranjan, Peeyush Kumar, Sudheer Kumar Vuyyuru, Bhaskar Kante, Sandeep K Mundhra, Rithvik Golla, Shubi Virmani, Raju Sharma, Peush Sahni, Prasenjit Das, Mani Kalaivani, Ashish Datt Upadhyay, Govind Makharia, Saurabh Kedia, Vineet Ahuja
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Abstract

Background and aims: Thiopurines are viable option for the treatment of inflammatory bowel disease [IBD] in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited.

Method: We performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis [UC] and Crohn's disease [CD]. Patients initiated on thiopurines early in the disease course [≤2 years] were compared with those started late [>2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up.

Results: A total of 988 [UC: 720, CD: 268] patients were included (male: 665 [60.8%], median age: 40 [32-51] years, median follow-up: 40 [19-81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC [81% and 80% vs 82% and 74%; p = 0.92] or CD [76% and 66% vs 72% and 51%, p = 0.32]. Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45-0.97; p = 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32-6.71; p = 0.008], steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26-5.68; p = 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27-0.80; p = 0.005] for CD were predictors of thiopurine effectiveness.

Conclusion: Thiopurines have sustained long-term effectiveness in both UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation.

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硫嘌呤类药物对炎症性肠病患者具有持续的长期疗效,这与开始使用时的病程无关:倾向得分匹配分析
背景和目的:在资源有限的国家,硫嘌呤类药物是治疗炎症性肠病(IBD)的可行选择。然而,有关开始使用硫嘌呤类药物时疾病持续时间对长期疗效影响的数据十分有限:我们对溃疡性结肠炎(UC)和克罗恩病(CD)患者的回顾性队列进行了倾向匹配分析。我们将病程早期(≤2 年)开始使用硫嘌呤类药物的患者与病程晚期(>2 年)开始使用硫嘌呤类药物的患者进行了比较。疗效的定义是在随访期间无需住院、无需使用抗肿瘤坏死因子(TNF)药物或手术,以及最少的类固醇需求量[2年内≤1个类固醇疗程]:共纳入988名[UC:720名,CD:268名]患者(男性:665名[60.8%],中位年龄:40岁[32-51岁],中位随访时间:40个月[19-81个月])。5 年和 10 年的总体有效率在 UC 中分别为 79% 和 72%,在 CD 中分别为 69% 和 63%。经过倾向得分匹配后,硫嘌呤起始时间早的组别和起始时间晚的组别在 UC [81% 和 80% vs 82% 和 74%; p = 0.92]或 CD [76% 和 66% vs 72% 和 51%, p = 0.32]的 5 年和 10 年有效率方面均无差异。男性性别对 UC(阴性:危险比 [HR]:0.67,95% 置信区间 [CI]:0.45-0.97;P = 0.03)、回肠受累 [阳性:HR:3.03,95% CI:1.32-6.71;P = 0.008]、类固醇依赖性疾病[阳性:HR:2.70,95% CI:1.26-5.68;P = 0.01]和CD的不良事件[阴性:HR:0.47,95% CI:0.27-0.80;P = 0.005]是硫嘌呤有效性的预测因素:结论:硫嘌呤类药物对 UC 和 CD 均有长期疗效。结论:硫嘌呤类药物对 UC 和 CD 均有持续的长期疗效,但与晚期使用硫嘌呤类药物相比,早期使用硫嘌呤类药物对疾病的长期预后没有更好的影响。
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来源期刊
Journal of Crohns & Colitis
Journal of Crohns & Colitis 医学-胃肠肝病学
CiteScore
15.50
自引率
7.50%
发文量
1048
审稿时长
1 months
期刊介绍: Journal of Crohns and Colitis is concerned with the dissemination of knowledge on clinical, basic science and innovative methods related to inflammatory bowel diseases. The journal publishes original articles, review papers, editorials, leading articles, viewpoints, case reports, innovative methods and letters to the editor.
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