P552 Prognosis of patients with Ulcerative Colitis in remission after thiopurines withdrawal
E. Moreno Rincón*1, F.J. Serrano Ruiz1, J.M. Benítez Cantero1, J.M. Vázquez Morón2, H. Pallarés Manrique2, J.M. Herrera Justiniano3, E. Leo Carnerero3, M.D.R. Gómez García4, M.J. Cabello Tapia4, M. Castro Fernández5, M. Rojas Feria5, L. Castro Laria6, F. Argüelles Arias6, R. Camargo Camero7, G. Alcaín Martínez7, E. Iglesias Flores1, V. García Sánchez1
1Hospital Universitario Reina Sofía, Gastroenterology Unit, Córdoba, Spain, 2Hospital Juan Ramón Jiménez, Gastroenterology, Huelva, Spain, 3Hospital Universitario Virgen del Rocío, Gastroenterology, Sevilla, Spain, 4Hospital Universitario Virgen de las Nieves, Digestive Department, Granada, Spain, 5Hospital de Valme, Gastroenterology, Sevilla, Spain, 6Hospital Universitario Virgen Macarena, Gastroenterology, Sevilla, Spain, 7Hospital Universitario Virgen de la Victoria, Gastroenterology, Malaga, Spain
The ideal length of treatment with thiopurines in ulcerative colitis (UC) patients in sustained remission remains unknown. It is widely accepted that the withdrawal of these drugs is associated with a worse outcome of the disease. The aim of this study is to analyze the clinical outcome after this withdrawal and to identify possible predictors of clinically significant relapse (CSR).
A multi-centre, observational and retrospective study was designed. 102 patients with UC that discontinued thiopurines (after a period of at least 6 months of treatment) in a situation of sustained free-steroids clinical remission were included. All the patients were followed-up until last revision or until CSR (defined as the occurrence of signs and symptoms of UC that required the administration of a rescue treatment).
The mean duration of the disease in all patients was 13 +/- 0.61 years, the mean time from diagnosis to the start of thiopurines was 48.14 +/- 5.51 months and the mean duration of total treatment with thiopurines was 60.87 +/- 4.89 months. After thiopurines were withdrawn, overall CSR was recorded in 32.35% of the patients. The cumulative percentage was 18.88% in the first year, 36.48% in the third year and 43.04% in the fifth year after withdrawal. In the univariate analysis, the total duration of treatment with thiopurines (p=0.0097) and time of free-steroids clinical remission before the suspension (p=0.0216) reached statistical significance. On multivariate analysis, predictors of recurrence were the time from diagnosis of UC until thiopurines were administered for the first time (HR 1.01, CI 95% 1.01-1.02, p=0.0397), a longer treatment with thiopurines (HR 0,15, IC 95% 0,03-0,66, p=0,0125), a situation of biological remission at the time of withdrawal (HR 0,004, IC 95% 0,0001-0,14, p=0,0021), the number of clinical relapses during treatment with thiopurines (HR 1.3, 95% CI 1.01-1.66, p=0.0298) and pancolitis (HR 5.01, 95% CI 1.95-26.43, p=0.0277).
The withdrawal of thiopurines in UC patients, although in sustained remission, is related to an increased risk of disease recurrence. Clinical variables such as the extent of the disease, the total duration of treatment or time of free-steroids clinical remission have been identified as factors to be considered before stopping these drugs. Further larger, controlled, randomized and prospective studies with long follow-up periods are required to research and clarify this issue.