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Thiopurine alone maintains remission in more than half of UC patients

Reuters Health - 14/10/2020 - Thiopurine monotherapy is an effective, durable treatment for ulcerative colitis (UC), but it is less likely to be effective in patients with Crohn's disease (CD), according to a study of nearly 12,000 patients.

About 53% of UC patients were able to maintain long-term remission on azathioprine (AZA) or 6-mercaptopurine (6MP) only, compared to a third of CD patients, Dr. Miles Parkes of Cambridge University Hospital in the U.K. and colleagues report in Gut. Median remission time with successful treatment was 16 years in CD patients and 17 years for UC patients.

"The strength of our study is the size of the data set and the length of follow-up," Dr. Parkes told Reuters Health by phone.

Biologics have been promoted heavily for treating IBD, with some opinion leaders saying thiopurines no longer have a role in IBD treatment, he noted. But with lifelong illnesses such as UC and CD, treatment durability is important, and many of the newer drugs have only been available for a few years, he added.

To assess long-term effectiveness of thiopurine monotherapy, Dr. Parkes and his team looked back at nearly 12,000 patients in the UK IBD BioResource database who were started on thiopurine monotherapy to maintain long-term remission, including 4,968 with UC and 6,960 with CD.

Based on more than 68,000 patient-years of exposure, 52.7% of the UC patients and 34.2% of the CD patients were able to remain on monotherapy with no need to escalate to a biologic or undergo surgery.

Multivariate analysis showed thiopurine monotherapy was significantly less effective for CD than UC (odds ratio, 0.47).

Patients who did not tolerate thiopurine treatment were significantly more likely to require surgery.

Patients with at least moderately severe CD should be treated early on with a thiopurine combined with a biologic, Dr. Parkes said. "That's probably our most effective treatment and likely to be our most durable treatment as well."

The findings show that thiopurines still have an important role to play in treating IBD, and clinicians shouldn't "rush past the old stuff too fast," he said, adding, "here's the evidence that it's effective, and remains effective over the long term."

"There's no Big Pharma stand at the conferences promoting a drug which has been around for the last 30 years," he added. "We all have to guard ourselves against these sorts of influences, and it's good to take an objective look at the data."

By Anne Harding

SOURCE: https://bit.ly/3lw9AJi Gut, online October 1, 2020.

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