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P431. Long-term efficacy of maintenance therapy with thiopurines in Crohn's disease

Y. Qiu, R. Mao, B.-l. Chen, Y. He, Z.-r. Zeng, M.-h. Chen, First Affiliated Hospital of Sun Yat-Sen University, Department of Gastroenterology, Guangzhou, China

Background

To evaluate the efficacy of thiopurines in patients with Crohn's disease. To identify predictive factors associated with the flare of disease.

Methods

Long-term incidence of flare was estimated in patients from a prospectively maintained Chinese IBD database using Kaplan–Meier analysis. Cox regression analysis was performed to identify potential predictive factors of flare.

Results

A total of 265 patients completed six months of thiopurines treatment. Overall, using a strict definition of relapse (including patients with a short relapse), the proportion of patients still in remission at 12, 24, 36, 48, and 60 months was 0.76, 0.62, 0.50, 0.37, and 0.26, respectively. The median time of clinical remission was 36.8 month (95% CI 25.8, 47.7). There was a total 101 disease-flare attack within an median time 9.37 months (IQR 4.07–17.20). Significant factors predictive of achieving remission are indications for thiopurines (P < 0.0001), more frequently expose to corticosteroids treatment prior to thiopurines (P = 0.006), a higher baseline hemoglobin (g/l) (P = 0.045), and a higher baseline hematocrit (P = 0.0018). Factors that were not significant were age at diagnosis, and lymphocyte count, disease behavior, median duration of disease, body mass index, intestinal surgery or appendectomy history, site of involvement, 5-ASA co-use, type of thiopurine, median dose of thiopurines, baseline leukocyte count, baseline PLT count, baseline ESR, baseline CRP. There was no sex difference. By multiple logistic regression the only independent factors in the model was indications for thiopurines. And fistulizing CD and postoperative maintenance are best indications for thiopurines maintenance therapy.

Conclusion

Maintenance therapy with thiopurines in Crohn's disease can achieve a 36.8 month disease-flare free clinical remission. Significant factors predictive of maintaining remission are indications for thiopurines, more frequently expose to corticosteroids treatment prior to thiopurines, a higher baseline hemoglobin, and hematocrit. Multivariate logistic regression identified fistulizing CD and postoperative maintenance are best indications for thiopurines maintenance therapy.