P501 Thiopurine withdrawal in patients with Crohn’s disease: the SURESTE study
E. Sánchez Rodríguez1, R. Sánchez Aldehuelo1, J. Guardiola2, A. Gutiérrez Casbas3, E. Domènech4, F. Bermejo5, M. Van-Domselaar6, F. Mesonero Gismero1, G. Suris2, R. Muñoz Perez3, M. Mañosa4, L. Jiménez Márquez5, A. Algaba García5, A. López sanroman1, SURESTE
1Hospital Universitario Ramón y Cajal, Servicio de Gastroenterologia y Hepatología, Madrid, Spain, 2Hospital Universitari de Bellvitge, Servicio de Aparato Digestivo, Barcelona, Spain, 3Hospital General Universitario de Alicante, Servicio Medicina Digestiva, alicante, Spain, 4Hospital Universitari Germans Trias i Pujol, Servicio de Aparato Digestivo, Badalona, Spain, 5Hospital Universitario de Fuenlabrada, Servicio de Aparato Digestivo, madrid, Spain, 6Hospital Universitario de Torrejón., Servicio de Aparato Digestivo, Madrid, Spain
Background
Thiopurine (TP) withdrawal in patients with Crohn’s disease (CD) in clinical remission (CR) is controversial. Our aim was to describe the evolution of CD patients in CR who discontinued TP prescribed to maintain a remission previously achieved with medical treatment, and to detect predictors of reactivation after withdrawal.
Methods
Multicentric observational retrospective study including CD patients in RC under TP treatment, who electively discontinued TP. Relapse was defined as the need to start any specific treatment for CD, including surgery. Informed consent was obtained from the inclusion in the Eneida database.
Results
We included 78 patients (52.6% females, age 45(19–77) years) of whom 57 presented an inflammatory, 12 a stricturing and 9 a penetrating behaviour; 31 patients had terminal ileum involvement, 9 colonic, 36 ilecolonic, and 2 ileocolonic plus upper gastrointestinal involvement, whilst 17 also had perianal disease. Mean disease duration was 13.47 (3.02–35.02) years. 48.7% had never smoked whilst 24.4% were active smokers. TP was started to maintain remission previously achieved with medical therapies in 78 patients (100%). Median azathioprine dose was 2.11 (1.3–2.6) mg/kg/d, and of 6-mercaptopurine (6MP) 1.44 (1–2) mg/kg/day. The median duration of TP treatment was 52.79 (3–268) months and of steroid-free remission 49.41 (1–177) months. Reasons for TP withdrawal were: patient choice/request in 20 (25.6%), physician proposal in 28 (25.7%), drug-related adverse events in 19 (24.4%) and miscellaneous in 11 (14.1%). By the time of TP discontinuation, median CRP was 5.08 mg/l (0.1–157.9), fecal calprotectin(FC) 282.38 µg/g (2.4-4430) and a mean 0.45 (0–4) in Harvey–Bradshaw Index (HBI); those who relapsed presented median CRP of 15.31 mg/l (0.1–125.31), fecal calprotectin (FC) 462.22 µg/g (90–1240) and a mean 5.46 (0–15) in HBI. These differences were statistically significant. During a 5.08 (0.12–13.05) years follow-up, 38 (48.1%) patients relapsed, with treatment duration being the only factor associated to risk of relapse (O
Conclusion
Thiopurine withdrawal in the context of sustained remission in CD is associated with relapse in almost half of the patients after a median follow-up of 5 years. Thiopurine treatment duration of shorter than 5 years was shown to carry greater risk for relapse.