Moreno-Rincón Estefanía, Benítez José Manuel, Serrano-Ruiz Francisco Javier, Vázquez-Morón Juan María, Pallarés-Manrique Héctor, Herrera-Justiniano José Manuel, Leo-Carnerero Eduardo, Gómez-García María Rosario, Cabello-Tapia María José, Castro-Fernández Manuel, Rojas-Feria María, Castro-Laria Luisa, Argüelles-Arias Federico, Camargo-Camero Raquel, Alcaín-Martínez Guillermo, Iglesias-Flores Eva, García-Sánchez Valle
*Department of Gastroenterology, IMIBIC (Maimónides Institute of Biomedical Research of Córdoba), University Hospital Reina Sofía, Córdoba, Spain; †Department of Gastroenterology, University Hospital Juan Ramón Jiménez, Huelva, Spain; ‡Department of Gastroenterology, University Hospital Virgen del Rocío, Sevilla, Spain; §Department of Gastroenterology, University Hospital Virgen de las Nieves, Granada, Spain; ‖Department of Gastroenterology, University Hospital Nuestra Señora de Valme, Sevilla, Spain; ¶Department of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain; and **Department of Gastroenterology, University Hospital Virgen de la Victoria, Málaga, Spain.
Inflamm Bowel Dis. 2015 Jul;21(7):1564-71. doi: 10.1097/MIB.0000000000000400.
The ideal length of treatment with thiopurines in patients with ulcerative colitis (UC) in sustained remission remains unknown. It is widely accepted that the drug withdrawal is associated with a worse outcome. The aim of this study was to analyze the outcome after this withdrawal and to identify predictors of relapse.
A multicenter and retrospective study was designed. A total of 102 patients with UC who discontinued thiopurines in a situation of sustained remission were included. All the patients were followed up until last revision or until relapse (understood as the occurrence of signs and symptoms of UC that required a rescue treatment).
After thiopurines withdrawal, overall relapse was recorded in 32.35% of the patients: 18.88% in the first year, 36.48% in the third, and 43.04% in the fifth year after withdrawal. On multivariate analysis, predictors of relapse were the time from diagnosis of UC until the starting of thiopurines (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.01-1.02; P = 0.039), the number of relapses before the withdrawal (HR, 1.3; 95% CI, 1.01-1.66; P = 0.029), pancolitis (HR, 5.01; 95% CI, 1.95-26.43; P = 0.028), the duration of treatment with thiopurines (HR, 0.15; 95% CI, 0.03-0.66; P = 0.013) and the situation of biological remission at withdrawal (HR, 0.004; 95% CI, 0.0001-0.14; P = 0.002).
The withdrawal of thiopurines in patients with UC, although in sustained remission, is related to a high relapse rate. Clinical variables such as the extent of the disease, the duration of treatment or time from diagnosis to the start of thiopurines should be considered before stopping these drugs.
溃疡性结肠炎（UC）患者在持续缓解期使用硫嘌呤类药物的理想治疗时长仍不明确。普遍认为停药与更差的预后相关。本研究旨在分析停药后的结局并确定复发的预测因素。
设计了一项多中心回顾性研究。纳入了102例在持续缓解期停用硫嘌呤类药物的UC患者。所有患者均随访至最后一次复查或复发（定义为出现需要抢救治疗的UC体征和症状）。
停用硫嘌呤类药物后，32.35%的患者出现总体复发：停药后第1年为18.88%，第3年为36.48%，第5年为43.04%。多因素分析显示，复发的预测因素包括从UC诊断到开始使用硫嘌呤类药物的时间（风险比[HR]，1.01；95%置信区间[CI]，1.01 - 1.02；P = 0.039）、停药前的复发次数（HR，1.3；95% CI，1.01 - 1.66；P = 0.029）、全结肠炎（HR，5.01；95% CI，1.95 - 26.43；P = 0.028）、硫嘌呤类药物的治疗时长（HR，0.15；95% CI，0.03 - 0.66；P = 0.013）以及停药时的生物学缓解情况（HR，0.004；95% CI，0.0001 - 0.14；P = 0.002）。
UC患者即使处于持续缓解期，停用硫嘌呤类药物也与高复发率相关。在停用这些药物之前，应考虑疾病范围、治疗时长或从诊断到开始使用硫嘌呤类药物的时间等临床变量。
