Intest Res.  2015 Jul;13(3):250-258. 10.5217/ir.2015.13.3.250.

Efficacy and Safety of Long-Term Thiopurine Maintenance Treatment in Japanese Patients With Ulcerative Colitis

• Yamada S
• Yoshino T
• Matsuura M
• Kimura M
• Koshikawa
• Minami N
• Toyonaga T
• Honzawa Y
• Nakase H

• KMID: 2174476
• DOI: http://doi.org/10.5217/ir.2015.13.3.250

Abstract

BACKGROUND/AIMS
The long-term clinical outcomes of patients with bio-naive ulcerative colitis (UC) who maintain remission with thiopurine are unclear. The aim of this study was to assess the long-term efficacy and safety of maintenance treatment with thiopurine in UC patients.
METHODS
This was a retrospective observational cohort analysis conducted at a single center. Between December 1998 and August 2013, 59 of 87 patients with bio-naive UC who achieved remission after induction with treatments other than biologics were enrolled. Remission maintenance with thiopurine was defined as no concomitant treatment needed other than 5-aminosalicylate without relapse. We assessed the remission-maintenance rate, mucosal healing rate, colectomy-free rate, and treatment safety in UC patients who received thiopurine as maintenance treatment.
RESULTS
The 84-month cumulative remission-maintenance and colectomy-free survival rates in the UC patients who were receiving maintenance treatment with thiopurine and 5-aminosalicylate were 43.9% and 88.0%, respectively. Of the 38 patients who underwent colonoscopy during thiopurine maintenance treatment, 23 (60.5%) achieved mucosal healing. Of the 59 patients who achieved clinical remission with thiopurine, 6 patients (10.2%) discontinued the thiopurine therapy because of adverse events.
CONCLUSIONS
Our study demonstrates the long-term efficacy and safety of thiopurine treatment in patients with bio-naive UC.

Keyword

Thiopurine; Colitis, ulcerative; Maintenance treatment

MeSH Terms

Asian Continental Ancestry Group*
Biological Products
Cohort Studies
Colitis, Ulcerative*
Colonoscopy
Humans
Mesalamine
Recurrence
Retrospective Studies
Survival Rate
Biological Products
Mesalamine

Figure

• 

  Fig. 1 Flow chart and cumurative remission maintenance and colectomy-free rate. (A) Clinical course of the patients with UC who were enrolled in this study. Of the 87 patients with UC who received various induction therapies, including 5-aminosalicylate (5-ASA), granulocyte-monocyte adsorption apheresis (GMAA), corticosteroids, and calcineurin inhibitors, 68 (78.2%) achieved a clinical response with induction treatment and thiopurine. Fifty-nine patients (67.8%) achieved clinical remission with thiopurine and 5-ASA after tapering the dose in the induction treatment, and 56 patients (64.4%) continued maintenance treatment with thiopurine. (B) Cumulative remission-maintenance rate. The cumulative remission-maintenance rate in 59 patients treated with thiopurine and 5-ASA after tapering the dose in the induction treatment was estimated to be 43.9% at 84 months. (C) Survival. The cumulative colectomy-free survival rate in the UC patients whose remission was maintained with thiopurine and 5-ASA was estimated to be 88.0% at 84 months.

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