OP17. Risk of colectomy in patients with ulcerative colitis under thiopurine treatment. Study of prevalence and predictive factors. ENEIDA project
A. Cañas-Ventura1, L. Marquez1, J. Panés2, E. Domènech3, J.P. Gisbert4, V. Garcia5, I. Marin-Jimenez6, F. Rodriguez-Moranta7, F. Gomollón Garcia8, X. Calvet9, O. Merino Ochoa10, E. Garcia-Planella11, N. Vazquez-Romero12, M. Esteve13, P. Nos14, A. Gutiérrez-Casbas15, I. Vera16, M. Andreu Garcia1
1Parc De Salut Mar Barcelona, Gastroenterology, Barcelona, Spain; 2Hospital Clinic Barcelona, CIBEREHD, Inflammatory Bowel Disease Unit, Barcelona, Spain; 3Hospital Universitari Germans Trias i Pujol, CIBEREHD, Servicio de Aparato Digestivo, Badalona, Spain; 4Hospital De La Princesa, CIBEREHD, Department of Gastroenterology, Madrid, Spain; 5Hospital Reina Sofia, Gastroenterology, Córdoba, Spain; 6Hospital General Gregorio Marañon, CIBEREHD, Madrid, Spain; 7Hospital Universitari de Bellvitge, Gastroenterology, Barcelona, Spain; 8Hospital Clinico Universitario, Servicio de Gastroenterologia, Zaragoza, Spain; 9Corporació Santaria Parc Tauli, CIBEREHD, Gastroenterology, Sabadell, Spain; 10Hospital De Cruces, Barakaldo, Spain; 11Hospital De La Santa Creu i De Sant Pau, Barcelona, Spain; 12Hospital General Universitario de Elche, Gastroenterology, Alicante, Spain; 13Hospital Universitari MútuaTerrassa, Gastroenterology, Terrassa, Spain; 14La Fe Hospital, CIBEREHD, Servicio de Aparato Digestivo, Valencia, Spain; 15Hospital General de Alicante, Gastroenterology, Alicante, Spain; 16Hospital Puerta de Hierro, Gastroenterology, Madrid, Spain
Background: Little is known about the risk of colectomy in patients with ulcerative colitis (UC) under thiopurine treatment (AZA/6MP), and considerably less about predictive factors of colectomy, which can be useful in order to consider different treatment strategies. The purpose of this study was to explore the prevalence of colectomy and the predictive factors of colectomy in an extensive cohort of patients with UC treated with AZA/6MP included in the ENEIDA project (Spanish registry of IBD patients).
Methods: Among 5,753 patients with UC, we selected 1,347 cases treated with AZA/6MP for more than 3 months (induction of remission 39%; maintenance of remission 61%). Forty-seven colectomies for displasia or cancer and 235 colectomies for active disease, which had never been treated with thiopurines, were excluded. We analyzed the age at diagnosis, familial history of IBD, extraintestinal manifestations, disease location, smoking status, apendicectomy, steroid-refractory pattern, steroid-dependent pattern, indication of AZA/6MP treatment, AZA/6MP duration treatment, need of AZA/6MP during or after the first year of UC diagnosis, treatment with ciclosporin or anti‑TNF not initiated simultaneously with AZA and anti-TNF+AZA combination therapy.
Results: Characteristics of the 1347 cases included: age at diagnosis: 35±14 years; gender: 45.7% female and disease location (Montreal classification): E1 4.1%; E2 39%; E3 55.9%. During follow-up (121±85 months), 127 patients (9.2%) underwent a colectomy. Survival analysis (KaplanMeier) showed that the beginning of AZA/6MP during the first year of the diagnosis, steroid-refractory disease, steroid-dependent disease, use of ciclosporin, use of anti‑TNF and extensive colitis, were associated to a lower survival time free of colectomy (p < 0.05). Cox regression analysis identified extensive colitis (OR 1.9; 95%IC 1.192.94), previous treatment with ciclosporin (OR 2.1; 95%IC 1.423.32); need of biological agents (OR 2.9; 95%IC 1.964.24); longer AZA/6MP duration treatment (OR 0.97; 95%IC 0.960.98) and the beginning of AZA/6MP during the first year of diagnosis (OR 4.2; 95%IC 2.215.23) as independent predictive factors of colectomy.
Conclusions: In UC, extensive diseases, early need of inmunosupressants after the diagnosis and the anti‑TNF requirement, are indicators of a higher risk of colectomy. An early anti-TNF+AZA combination therapy in patients that need thiopurine during the first year may be considered to reduce the risk of colectomy.