Intest Res.  2015 Jul;13(3):266-273. 10.5217/ir.2015.13.3.266.

Efficacy of Thiopurines in Biologic-Naive Japanese Patients With Crohn's Disease: A Single-Center Experience

• Yoshino T
• Matsuura M
• Minami N
• Yamada S
• Honzawa Y
• Kimura M
• Koshikawa
• Madian A
• Toyonaga T
• Nakase H

• KMID: 2174482
• DOI: http://doi.org/10.5217/ir.2015.13.3.266

Abstract

BACKGROUND/AIMS
Early use of biologics in patients with Crohn's disease (CD) improves quality of life. However, the effects of the early use of immunomodulators on long-term outcomes remain unclear. This study aimed to evaluate the effects of immunomodulators in patients with CD.
METHODS
Between January 2004 and December 2011, 47 biologic-naive CD patients treated with thiopurines alone for remission maintenance were analyzed. The patients were classified into 2 groups depending on the presence or absence of digestive complications. We evaluated the efficacy of and predictive factors for thiopurine use for remission maintenance.
RESULTS
The cumulative relapse rates at 24 and 60 months were 13.7% and 35.4%, respectively. Regarding patient characteristics, there was a significant difference in patient history of surgery between the non-relapse and relapse groups (P=0.021). The cumulative relapse rate was lower in patients without a history of surgery than in those with such a history (27.2% and 52.9% at 60.0 months, respectively). Multivariate analysis suggested that the prevalence of stricturing and penetrating complications is an independent factor for relapse. The cumulative relapse rate in patients without a history of surgery was significantly lower in the non-stricturing and non-penetrating group than in the stricturing and penetrating group (11.8% at 85.0 months vs. 58.5% at 69.0 months; P=0.036).
CONCLUSIONS
Thiopurine use might be beneficial for the long-term maintenance of remission in biologic-naive Crohn's disease patients without digestive complications and a history of surgery.

Keyword

Thiopurine; Biologic-naive; Crohn disease

MeSH Terms

Asian Continental Ancestry Group*
Biological Products
Crohn Disease*
Humans
Immunologic Factors
Multivariate Analysis
Prevalence
Quality of Life
Recurrence
Biological Products
Immunologic Factors

Figure

• 

  Fig. 1 The overall cumulative relapse rate in 47 biologic-naive CD patients. The overall cumulative relapse rate was 35.4% at 85.0 mo, on the basis of Kaplan-Meier analysis.

• 

  Fig. 2 The cumulative relapse rates in biologic-naive CD patients with and those without a history of surgery. The cumulative relapse rate in CD patients without a history of surgery was 27.2% at 85.0 mo (solid line), and that in those with such a history was 52.9% at 77.6 mo (dashed line) (P=0.071).

• 

  Fig. 3 In biologic-naive CD patients without a history of surgery, the cumulative relapse rates of patients with and those without digestive complications were evaluated. The 33 biologic-naive CD patients without a history of surgery were classified as follows: B1 (non-stricturing and non-penetrating) and B2+B3 (stricturing and penetrating) patients. The cumulative relapse rate in the B1 group was 11.1% at 85.0 mo (solid line) and that in the B2+B3 group was 58.5% at 69.0 mo (dashed line) (P=0.036).

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