Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua 35128, Italy.
World J Gastroenterol. 2023 Jul 21;29(27):4334-4343. doi: 10.3748/wjg.v29.i27.4334.
There is no consensus on the recommended duration of and optimal time to stop azathioprine (AZA) therapy in inflammatory bowel disease (IBD). Determining the optimal duration and cessation time can help to balance the risks of long-term intake with the possibility of relapse after cessation.
To describe the events following AZA cessation.
Retrospective analysis was performed to examine data from adult patients affected by IBD who were followed at the University of Padua and had started but then discontinued AZA between 1995 and 2022. Data on therapy duration, reasons for cessation, and type of relapse after cessation were collected. Cox regression models were used to estimate the risk of relapse in different subgroups.
A total of 133 ulcerative colitis patients and 141 Crohn's disease patients were included. Therapy with AZA was stopped in the 1 year in approximately 34% of patients but was continued for more than 10 years in approximately 10% of cases. AZA discontinuation was due to primary failure or disease relapse in 30% of patients and due to disease remission in 25.2% of patients. Most of the remaining cases stopped AZA therapy due to side effects (primarily clinical intolerance, cytopenia, and pancreatic disease). Patients who stopped AZA for clinical remission had an 83% lower risk of relapse during the observation time than other groups, with a relapse-free rate of 89% after 1 year and 79% after 2 years.
AZA administration is effective and safe, but it requires careful monitoring for potential minor and major side effects. Only 10% of patients who achieved remission with AZA needed a new treatment within 1 year of drug interruption.
在炎症性肠病（IBD）中，尚无关于推荐的硫唑嘌呤（AZA）治疗持续时间和最佳停药时间的共识。确定最佳的持续时间和停药时间有助于平衡长期摄入的风险与停药后复发的可能性。
描述 AZA 停药后的情况。
对在帕多瓦大学接受治疗的 IBD 成年患者进行回顾性分析，这些患者在 1995 年至 2022 年期间开始但随后停止使用 AZA。收集有关治疗持续时间、停药原因和停药后复发类型的数据。使用 Cox 回归模型估计不同亚组的复发风险。
共纳入 133 例溃疡性结肠炎患者和 141 例克罗恩病患者。大约 34%的患者在 1 年内停止 AZA 治疗，但大约 10%的患者持续治疗超过 10 年。AZA 停药的原因是原发性失败或疾病复发的占 30%，疾病缓解的占 25.2%。其余大多数患者因副作用（主要是临床不耐受、血细胞减少和胰腺疾病）停止 AZA 治疗。因临床缓解而停止 AZA 治疗的患者在观察期间复发风险降低 83%，1 年后无复发率为 89%，2 年后无复发率为 79%。
AZA 给药有效且安全，但需要密切监测潜在的轻微和严重副作用。仅 10%的因 AZA 治疗而缓解的患者在停药后 1 年内需要新的治疗。
