Department of Internal Medicine, McGill University Health Center, Rm D05.5840, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.
Centre Hospitalier Universitaire Sainte-Justine, Unité de Pharmacologie Clinique, Montreal, QC, H3T 1C5, Canada.
Dig Dis Sci. 2021 May;66(5):1650-1657. doi: 10.1007/s10620-020-06427-8. Epub 2020 Jun 26.
Immunomodulator monotherapy is an important component in the treatment of inflammatory bowel disease (IBD). However, there is conflicting literature about thiopurines maintaining long-term remission in patients with active IBD.
To determine the durable clinical remission rate in adults with Crohn's disease (CD) or ulcerative colitis (UC) on thiopurine monotherapy over 5 years.
We performed a retrospective analysis of adult patients identified at McGill University Health Centre from 2009 to 2012. We included IBD patients who initiated thiopurine monotherapy and were in remission for at least 3 months (Harvey-Bradshaw Index (HBI) < 5 points for CD and partial Mayo Score (pMS) < 2 points in UC). The primary endpoint was sustained clinical remission on thiopurines during a 5-year follow-up. This included patients who had not relapsed or discontinued the drug due to side effects. The secondary endpoint was clinical relapse over the follow-up period, which was defined as HBI > 5 in CD and pMS > 2 in UC.
There were 148 patients included in the study (100 CD; 48 UC). At 5 years, 23% (34/148) patients remained in clinical remission on thiopurine monotherapy (25 CD and 9 UC patients). Thirty-three percent (33/100) of CD and 46% (22/48) of UC patients relapsed while on thiopurines. There was no difference in relapse rates between CD and UC patients. Eighty-four percent (42/50) of patients with CD with side effects and all UC (17/17) patients who experienced side effects discontinued the drug.
This analysis demonstrates that there is poor sustainability of clinical remission in IBD patients on thiopurine monotherapy given that a high proportion of patients discontinue thiopurines due to either relapse or side effects.
免疫调节剂单药治疗是炎症性肠病（IBD）治疗的重要组成部分。然而，关于硫嘌呤能否维持活动期 IBD 患者的长期缓解存在相互矛盾的文献。
确定在 5 年内接受硫嘌呤单药治疗的克罗恩病（CD）或溃疡性结肠炎（UC）成年患者的持久临床缓解率。
我们对 2009 年至 2012 年在麦吉尔大学健康中心就诊的成年患者进行了回顾性分析。我们纳入了开始硫嘌呤单药治疗且缓解至少 3 个月的 IBD 患者（CD 的 Harvey-Bradshaw 指数（HBI）<5 分，UC 的部分 Mayo 评分（pMS）<2 分）。主要终点是在 5 年随访期间硫嘌呤持续的临床缓解。这包括因副作用而未复发或停药的患者。次要终点是随访期间的临床复发，定义为 CD 的 HBI>5 和 UC 的 pMS>2。
本研究共纳入 148 例患者（100 例 CD；48 例 UC）。5 年后，23%（34/148）的患者继续接受硫嘌呤单药治疗（25 例 CD 和 9 例 UC 患者）处于临床缓解状态。33%（33/100）的 CD 和 46%（22/48）的 UC 患者在接受硫嘌呤治疗时复发。CD 和 UC 患者的复发率无差异。42%（50 例 CD 中有 21 例）有副作用的患者和所有（17 例 UC 中有 17 例）出现副作用的患者停止使用该药物。
本分析表明，由于相当一部分患者因复发或副作用而停止使用硫嘌呤，接受硫嘌呤单药治疗的 IBD 患者的临床缓解可持续性较差。
