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P631 Mesalamine versus azathioprine for maintenance treatment after steroid-induced remission in pediatric ulcerative colitis

D. Sánchez Hernández*, C. Ruiz Hernández, G. Pujol Muncunill, V. Varea Calderón, J. Martín de Carpi

Hospital Sant Joan de Déu, Pediatric IBD Unit, Barcelona, Spain

Background

Guidelines for the treatment of Ulcerative Colitis (UC), both in adult and pediatric patients,recommend the use of salicylates as first-line maintenance treatment even in moderate-to-severe disease after steroidinduced remission. Our aim is to compare the efficacy of two maintenance strategies (mesalamine and azathioprine) for

pediatric UC after steroid-induced remission at diagnosis.

Methods

Patients with UC diagnosed in our center (January 2008-December 2013), who needed treatment with systemic steroids to induce remission were retrospectively studied. Patients receiving mesalamine and those receiving azathioprine (AZA) were compared.

Results

16 patients were included. Seven patients received mesalamine (group 1) and 9 AZA (group 2). PUCAI at

diagnosis, extension, and duration of steroid treatment were comparable.

Group 1: Mean time until first relapse was 22 weeks. During the follow-up all the seven patients (100%) needed a change in maintenance treatment due to relapse of the disease.

Group 2: Mean time until first relapse was 30 weeks. During the follow-up 5 patients (55%) needed a change of

treatment; 1 patient was switched to 5ASA after toxicity attributable to AZA and 4 patients after relapse.

We found statistically significant differences in the number of patients with failure of initial treatment (100% in group 1, 55% in group 2, p<0.04).

Conclusion

Treatment with azathioprine is more effective than salicylates for maintaining the steroid-induced remission

in pediatric UC at diagnosis. The course of the disease in these patients is severe enough to determine the need for treatment escalation in 55% of the patients even on AZA since diagnosis.