Colon to Rectum
J Crohns Colitis. 2024;18(2):192–203
Thiopurines have sustained long-term effectiveness in patients with inflammatory bowel disease, which is independent of disease duration at initiation: A propensity score matched analysis
Background and aims: Thiopurines are viable option for the treatment of inflammatory bowel disease (IBD) in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited. Method: The authors performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis (UC) and Crohn’s disease (CD). Patients initiated on thiopurines early in the disease course (≤ 2 years) were compared with those started late (> 2 years). Effectiveness was defined as no requirement for hospitalization, anti-tumor necrosis factor (TNF) agents, or surgery, and minimum steroid requirement (≤ 1 steroid course in 2 years) during follow-up.
Results: A total of 988 patients (UC: 720, CD: 268) were included (male: 665 [60.8%], median age: 40 [32–51] years, median follow-up: 40 [19–81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC (81% and 80% vs. 82% and 74%; p = 0.92) or CD (76% and 66% vs. 72% and 51%, p = 0.32). Male sex for UC (negative: hazard ratio [HR] = 0.67, 95% confidence interval [CI]: 0.45–0.97; p = 0.03), and ileal involvement (positive: HR = 3.03, 95% CI: 1.32–6.71; p = 0.008), steroid-dependent disease (positive: HR = 2.70, 95% CI: 1.26–5.68; p = 0.01) and adverse events (negative: HR = 0.47, 95% CI: 0.27–0.80; p = 0.005) for CD were predictors of thiopurine effectiveness.
Conclusion: Thiopurines have sustained long-term effectiveness in both ulcerative colitis and Crohn’s disease. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation.