Mallet Anne-Laure, Bouguen Guillaume, Conroy Guillaume, Roblin Xavier, Delobel Jean-Bernard, Bretagne Jean-François, Siproudhis Laurent, Peyrin-Biroulet Laurent
Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.
Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France; Inserm 991, University of Rennes 1, France; CIC1414, Université de Rennes 1, France.
Dig Liver Dis. 2017 Mar;49(3):280-285. doi: 10.1016/j.dld.2016.12.001. Epub 2016 Dec 13.
Efficacy of azathioprine (AZA) in refractory ulcerative proctitis (UP) is unknown.
All patients treated with AZA for refractory UP in three referral centers between 2002 and 2012 were included. "Treatment success" in the long-term was defined as the absence of colectomy during follow-up, no need for anti-TNF during follow-up, no ongoing systemic steroids use, no adverse event leading to AZA withdrawal, and clinically quiescent disease at last follow-up.
Of the 1279 adult patients with ulcerative colitis, 25 patients were treated with AZA for refractory UP (median disease duration 4.9 years). Of these, 4 had no short-term clinical assessment. Of the remaining 21, 4 were primary non responders to AZA, 7 discontinued AZA for adverse events and 10 showed clinical improvement. At the long-term assessment at last follow up after a median of 46 months, 5 patients had treatment success and were still on AZA treatment, the remaining 20 were treatment failures. Of these, 5 discontinued AZA for adverse events and 15 were treated with infliximab (clinical response in 11 patients, primary non-response in one patient, and 3 underwent colectomy).
AZA may be efficacious in maintaining clinical response in one-fifth of patients with refractory UP in a real-life setting.
硫唑嘌呤（AZA）在难治性溃疡性直肠炎（UP）中的疗效尚不清楚。
纳入2002年至2012年间在三个转诊中心接受AZA治疗难治性UP的所有患者。长期“治疗成功”定义为随访期间未行结肠切除术、随访期间无需使用抗TNF药物、未持续使用全身性类固醇、无导致停用AZA的不良事件以及最后一次随访时临床疾病静止。
在1279例成年溃疡性结肠炎患者中，25例接受AZA治疗难治性UP（疾病持续时间中位数为4.9年）。其中，4例未进行短期临床评估。在其余21例中，4例对AZA原发性无反应，7例因不良事件停用AZA，10例显示临床改善。在中位46个月后的最后一次随访长期评估中，5例治疗成功且仍在接受AZA治疗，其余20例治疗失败。其中，5例因不良事件停用AZA，15例接受英夫利昔单抗治疗（11例有临床反应，1例原发性无反应，3例行结肠切除术）。
在现实环境中，AZA可能对五分之一的难治性UP患者维持临床反应有效。
