硫唑嘌呤治疗炎症性袋状疾病的有效性和安全性：GETECCU的RESERVO研究结果
Effectiveness and safety of azathioprine for inflammatory pouch disorders: results from the RESERVO study of GETECCU.
作者信息
Mesonero Francisco, Zabana Yamile, Fernández-Clotet Agnès, Leo-Carnerero Eduardo, Caballol Berta, Núñez-Ortiz Andrea, García María José, Bertoletti Federico, Mínguez Alejandro, Suris Gerard, Casis Begoña, Ferreiro-Iglesias Rocío, Calafat Margalida, Jiménez Itxaso, Miranda-Bautista José, Lamuela Luis Javier, Fajardo Ingrid, Torrealba Leyanira, Nájera Rodrigo, Sáiz-Chumillas Rosa María, González Irene, Vicuña Miren, García-Morales Natalia, Gutiérrez Ana, López-García Alicia, Benítez José Manuel, Rubín de Célix Cristina, Tejido Coral, Brunet Eduard, Hernández-Camba Alejandro, Suárez Cristina, Rodríguez-Lago Iago, Piqueras Marta, Castaño Andrés, Ramos Laura, Sobrino Ana, Rodríguez-Grau María Carmen, Elosua Alfonso, Montoro Miguel, Baltar Ruth, Huguet José María, Hermida Benito, Caballero-Mateos Antonio, Sánchez-Guillén Luis, Bouhmidi Abdel, Pajares Ramón, Baston-Rey Iria, López-Sanromán Antonio, Albillos Agustin, Barreiro-de Acosta Manuel
机构信息
Inflammatory Bowel Disease Unit, Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Cra. Colmenar km 9.1, Madrid 28034, Spain.
Hospital Universitario Mútua Terrassa, Terrassa, Spain.
出版信息
Therap Adv Gastroenterol. 2024 Mar 4;17:17562848241234476. doi: 10.1177/17562848241234476. eCollection 2024.
BACKGROUND
The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders.
OBJECTIVE
To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders.
DESIGN
This was a retrospective and multicentre study.
METHODS
We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI).
RESULTS
In all, 63 patients were included [54% males; median age, 49 (28-77) years]. The therapy was used to treat pouchitis ( = 37) or Crohn's disease of the pouch ( = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11-55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2-4) to 1 (range 0-3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy.
CONCLUSION
Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option.
背景
硫唑嘌呤在袋炎及其他袋状疾病中的应用尚未得到充分研究。
目的
评估硫唑嘌呤作为炎症性袋状疾病维持治疗的有效性和安全性。
设计
这是一项回顾性多中心研究。
方法
我们纳入了诊断为炎症性袋状疾病且接受硫唑嘌呤单药治疗的患者。基于大便频率正常化、无疼痛、无排便急迫感或瘘管排出物（临床缓解），或这些症状的任何改善（临床反应），在1年时和长期评估有效性。使用袋炎疾病活动指数（PDAI）评估内镜反应。
结果
总共纳入63例患者[男性占54%；中位年龄49（28 - 77）岁]。该疗法用于治疗袋炎（n = 37）或袋状克罗恩病（n = 26）。12个月时的临床反应、缓解和无反应率分别为52%、30%和18%。中位随访23个月（四分位间距11 - 55）后，19例患者（30%）处于临床缓解，45例（66%）停止治疗。对19例患者评估了内镜变化。PDAI评分从3（范围2 - 4）降至1（范围0 - 3）。总共21例患者（33%）出现不良事件，16例（25%）需要停止治疗。
结论
硫唑嘌呤长期治疗炎症性袋状疾病可能有效，可作为一种治疗选择。
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