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Long-term outcome of patients with Crohn's disease who respond to azathioprine

The latest issue of Clinical Gastroenterology & Hepatology investigates long-term outcome of patients with Crohn's disease who respond to azathioprine.

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Little is known about the long-term outcomes of patients with Crohn's disease who have a complete response to therapy with azathioprine.

Dr Marine Camus from France evaluated the long-term effects of azathioprine in responders.

The team collected data from the MICISTA registry on consecutive Crohn's disease patients treated with azathioprine from 1987 to 1999 who responded to therapy, and followed up until 2011.

Data were compared with those from 440 matched patients with Crohn's disease who did not receive immunosuppressants during the same inclusion period.

The doctors found that the cumulative rate of sustained remission 10 years after treatment with azathioprine was 38%.

Among patients exposed to azathioprine during a prospective follow-up period, the percentage of patient-years with active disease was 18%.

The researchers assesed that compared with the control group, at baseline, responders were more often active smokers with significantly more extensive disease, perianal lesions, and extradigestive manifestations.

Sustained remission 10 years after treatment with azathioprine was 38%
Clinical Gastroenterology & Hepatology

During follow-up evaluation, responders had a significantly reduced risk of intestinal surgery and perianal surgery.

The team of doctors noted that a significantly higher percentage of responders developed cancers, including nonmelanoma skin cancers, compared with controls.

Survival rates after 20 years were 93% of responders vs 98% of controls.

Dr Marine's team concluded, "Based on a study at a single center, patients with Crohn's disease who responded to azathioprine had a smaller proportion of patient-years with active disease, and were less likely to be hospitalized or undergo intestinal surgery, than patients with Crohn's disease who did not receive immunosuppressants."

"These benefits, however, could be offset by an increased risk of malignancies."

Clin Gastroenterol Hepatol 2013: 12(4): 389-94
28 March 2013

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