Relapse after withdrawal of thiopurines

Since long-term treatment with thiopurines is associated with an increased risk of opportunistic infection, lymphoma, and other malignancies, treatment withdrawal should be considered in patients who are in deep remission.

The Royal Bournemouth Hospital in the United Kingdom looked at the consequences of discontinuing thiopurine and found that 28 of 72 patients (38.8%) relapsed: 17 patients with ulcerative colitis (60.7%) and 11 with Crohn’s disease (39.3%) [1]. Of these, 79.4% relapsed within 3 years. Reassuringly, 71.5% achieved remission on re-starting AZA/methotrexate/mesalazine. Interestingly, 3 of their patients were identified to be in remission with faecal calprotectin but had mild inflammation on endoscopy; these 3 patients subsequently relapsed. This may suggest the need to establish remission endoscopically rather than using faecal calprotectin alone.

1. Radhakrishnan P, et al. ECCO 2019, P667.



Posted on 9 May, 20199 April, 2024