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P525. Crohn's disease outcome in patients under azathioprine: a tertiary referral center experience

J. Santos-Antunes1, F. Magro1, F. Vilas-Boas1, E. Rodrigues-Pinto1, R. Coelho1, O. Ribeiro2, S. Lopes1, G. Macedo1, 1Centro Hospitalar São João, Gastroenterology, Porto, Portugal, 2Centro Hospitalar S. João, Centre for Research in Health Informatics Systems and Technologies (CINTESIS), Porto, Portugal

Background

Azathioprine is widely applied in the treatment of Crohn's disease; its efficacy has been showed in several works, but real-life data regarding its use is scarce. The aim of this work was to address the outcome of patients with Crohn's disease under azathioprine in the real-life setting.

Methods

Crohn's disease patients followed at an Inflammatory Bowel Disease Outpatient Clinic under azathioprine were consecutively enrolled, being allocated in one of four groups. Two groups included patients on treatment with this drug, regarding the two major indications for its use - prevention of post-operative recurrence and steroid-dependent disease; a third group included patients who needed infliximab in addition to azathioprine and a fourth group comprised patients who did not tolerate azathioprine, that were only mentioned for descriptive purposes and were not included in further analysis. Data regarding number, median time and rates per person per year for hospitalization and surgeries were analyzed.

Results

A total of 221 patients were enrolled, 180 on azathioprine due to steroid-dependency (64 needing additional treatment with infliximab) and 41 for prevention of post-operative recurrence. Overall, steroid-free remission was obtained in 38% of the patients. In the steroid-dependent group, immunosuppression significantly decreased the number of hospitalized patients (64% vs 36%; p < 0.001), but not the number or the rates per person per year of patients needing surgery. Azathioprine as a post-operative drug was effective in decreasing hospitalizations and surgeries. The addition of infliximab decreased the number of patients hospitalized (p = 0.009) and hospitalization rates per person per year (0.23 vs 0.07; p < 0.001), but had no effect in the surgery rates per person per year. Sixty patients (27%) experienced adverse effects with AZA, 39 of them requiring discontinuation of the drug.

Conclusion

In this real-life study, azathioprine had a long-term steroid sparing effect and reduced hospitalizations. Combination with infliximab reduced hospitalizations but did not decrease the surgery rate.