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P582. Azathioprine therapy in Crohn's disease patients: a 16-year cohort analysis

A.M. Oliveira1, C. Rodrigues1, F. Cardoso1, L. Ricardo1, S. Alberto1, L. Santos1, D. Horta1, A. Martins1, J. Reis1, J.R. Deus1, 1Hospital Prof. Doutor Fernando Fonseca, Portugal

Background

Thiopurines have clearly proven efficacy in inflammatory bowel disease therapy especially, in maintenance of clinical remission.

The aim of this study was to access clinical efficacy of azathioprine in Crohn's disease patients followed at a Portuguese hospital between January 1996 and March 2012.

 

Methods

The data in this retrospective study are based on a 16-year cohort of Crohn's disease patients with previous or present azathioprine therapy.

We assessed patients' demographics, variables of Montreal classification, previous surgery, corticodependency/corticoresistance, concomitant biologic therapy, and effectiveness of azathioprine therapy and side effects.

 

Results

A total of 135 Crohn's disease patients were included (55% female), all patients were treated with azathioprine. Median duration of the disease at start of azathioprine therapy was 6 years. Twenty-nine (22%) patients were corticodependent; 8 (6%) were corticoresistant; 49 (38%) had perianal fistulizing Crohn's disease; 43 (33%) patients had undergone bowel surgery.

Azathioprine was continued in 102/135 (76%) and discontinued in 33/135 (24%) patients. The proportion of patients still using thiopurines and in remission at 3, 6, 12, 24 and 60 months was 97%, 96%, 89%, 78%, and 47%, respectively. Of those patients still using thiopurines 22 (21%) received concomitant biologic therapy.

The reasons for discontinuation of azathioprine were: long term clinical remission (n = 12); refractoriness (n = 3); adverse events (n = 8); development of non related carcinoma during the study (n = 4), and death (n = 6).

Eight (6%) patients died during the study [pneumonia (n = 2), sepsis (n = 2), neoplasia (n = 2), mesenteric thrombosis (n = 1), cardiovascular event (n = 1)].

 

Conclusion

In this cohort, the most frequent indication for azathioprine treatment in Crohn's disease patients was perianal fistulizing disease.

Azathioprine was considered effective in almost half of Crohn's disease patients after 5 years of treatment.

Only ∼6% of patients discontinued azathioprine due to adverse events, majority did so in the first three months.