Magro Fernando, Santos-Antunes João, Vilas-Boas Filipe, Rodrigues-Pinto Eduardo, Coelho Rosa, Ribeiro Orquídea Silva, Lopes Susana, Macedo Guilherme
Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; Institute for Molecular and Cell Biology, Porto, Portugal.
Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto, Portugal; Department of Biochemistry (U38-FCT), Faculty of Medicine, University of Porto, Portugal.
J Crohns Colitis. 2014 Jul;8(7):617-25. doi: 10.1016/j.crohns.2013.11.020. Epub 2013 Dec 12.
Azathioprine is of major importance in the treatment of Crohn's disease; its efficacy has been showed in several works, but real-life data regarding its use is scarce. Our aim was to address the outcome of patients with Crohn's disease under azathioprine in the real-life setting.
Crohn's disease patients followed at an Inflammatory Bowel Disease Outpatient Clinic under azathioprine were consecutively enrolled, being allocated in one of four groups. Two groups included patients on treatment with this drug, regarding its two major indications - prevention of post-operative recurrence and steroid-dependent disease; a third group included patients who needed infliximab in addition to azathioprine and a fourth group comprised patients who did not tolerate azathioprine.
A total of 221 patients were enrolled, 180 on azathioprine due to steroid-dependency (64 needing additional treatment with infliximab) and 41 for prevention of post-operative recurrence. Steroid-free remission was obtained in 48%. Immunosuppression decreased the number of hospitalized patients (64% vs 36%; p<0.001), but not the surgery rates per person per year. Azathioprine as a post-operative drug was effective in decreasing hospitalizations. The addition of infliximab decreased the number of patients hospitalized (p=0.009) and hospitalization rates per person per year (p<0.001), but had no effect in the surgery rates per person per year. Sixty patients (23%) experienced adverse effects with AZA, 39 requiring discontinuation of the drug.
In this real-life study, azathioprine had a long-term steroid sparing effect and reduced hospitalizations. Combination with infliximab reduced hospitalizations but did not decrease the surgery rate.
硫唑嘌呤在克罗恩病的治疗中具有重要意义；其疗效已在多项研究中得到证实，但关于其实际应用的数据却很匮乏。我们的目的是探讨在实际临床环境中接受硫唑嘌呤治疗的克罗恩病患者的治疗结果。
连续纳入在炎症性肠病门诊接受硫唑嘌呤治疗的克罗恩病患者，并将其分为四组。两组患者根据硫唑嘌呤的两个主要适应证接受该药物治疗，即预防术后复发和治疗激素依赖型疾病；第三组患者除硫唑嘌呤外还需要使用英夫利昔单抗；第四组患者为不耐受硫唑嘌呤的患者。
共纳入221例患者，其中180例因激素依赖而使用硫唑嘌呤（64例需要联合英夫利昔单抗治疗），41例用于预防术后复发。48%的患者实现了无激素缓解。免疫抑制减少了住院患者数量（64%对36%；p<0.001），但未降低每年的人均手术率。硫唑嘌呤作为术后用药可有效减少住院次数。联合使用英夫利昔单抗减少了住院患者数量（p=0.009）和每年的人均住院率（p<0.001），但对每年的人均手术率没有影响。60例患者（23%）出现了硫唑嘌呤相关不良反应，其中39例需要停药。
在这项实际临床研究中，硫唑嘌呤具有长期的激素节省作用并减少了住院次数。与英夫利昔单抗联合使用可减少住院次数，但未降低手术率。
