Azathioprine Withdrawal in Patients With Crohn's Disease Maintained on Prolonged Remission: A High Risk of Relapse

Clinical Gastroenterology and Hepatology

Volumn 7, Issue 1, 2009, Pages 80-85

  Treton, Xavier ^a   Bouhnik, Yoram ^a   Mary, Jean Yves ^b   Colombel, Jean Frédéric ^c   Duclos, Bernard ^d   Soule, Jean Claude ^e   Lerebours, Eric ^f   Cosnes, Jacques ^g   Lemann, Marc ^h  

^a BEAUJON HOSPITAL   (France)

^b INSERM   (France)

^c LILLE UNIVERSITY HOSPITAL   (France)

^d HÔPITAL DE HAUTEPIERRE   (France)

^e BICHAT HOSPITAL   (France)

^f HÔPITAL CHARLES NICOLLE   (France)

^g HÔPITAL SAINT ANTOINE   (France)

^h SAINT LOUIS HOSPITAL   (France)

Author keywords

[No Author keywords available]

Indexed keywords

AMINOSALICYLIC ACID DERIVATIVE; AZATHIOPRINE; C REACTIVE PROTEIN; HEMOGLOBIN; IMMUNOSUPPRESSIVE AGENT; INFLIXIMAB; METHOTREXATE; PLACEBO; STEROID;

ADULT; ARTICLE; BREAST CANCER; CHICKENPOX; CLINICAL EVALUATION; CONTROLLED STUDY; CROHN DISEASE; DISEASE ASSOCIATION; DRUG DOSE REDUCTION; DRUG FATALITY; DRUG WITHDRAWAL; FEMALE; FOLLOW UP; HIGH RISK PATIENT; HUMAN; LEUKOPENIA; LONG TERM CARE; MAINTENANCE THERAPY; MAJOR CLINICAL STUDY; MALE; NEUTROPHIL COUNT; PROGNOSIS; RELAPSE; REMISSION; RISK FACTOR; TREATMENT DURATION;

EID: 58149136086     PISSN: 15423565     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.cgh.2008.08.028     Document Type: Article

References (41)

1. O'Donoghue D.P., Dawson A.M., Powell-Tuck J., et al. Double-blind withdrawal trial of azathioprine as maintenance treatment for Crohn's disease. Lancet 2 (1978) 955-957
2. Candy S., Wright J., Gerber M., et al. A controlled double blind study of azathioprine in the management of Crohn's disease. Gut 37 (1995) 674-678
3. Present D.H., Korelitz B.I., Wisch N., et al. Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med 302 (1980) 981-987
4. Markowitz J., Grancher K., Kohn N., et al. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology 119 (2000) 895-902
5. Pearson D.C., May G.R., Fick G.H., et al. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med 123 (1995) 132-142
6. Pearson DC, May GR, Fick G, et al. Azathioprine for maintaining remission of Crohn's disease. Cochrane Database Syst Rev 20002CD000067.
7. Modigliani R. Immunosuppressors for inflammatory bowel disease: how long is long enough?. Inflamm Bowel Dis 6 (2000) 158 251-257
8. Bouhnik Y., Lemann M., Mary J.Y., et al. Long-term follow-up of patients with Crohn's disease treated with azathioprine or 6-mercaptopurine. Lancet 347 (1996) 215-219
9. Lemann M., Mary J.Y., Colombel J.F., et al. A randomized, double-blind, controlled withdrawal trial in Crohn's disease patients in long-term remission on azathioprine. Gastroenterology 128 (2005) 1812-1818
10. Harvey R.F., and Bradshaw J.M. A simple index of Crohn's-disease activity. Lancet 1 (1980) 514
11. Kaplan E.L., and Meier P. Nonparametric estimation for incomplete observations. J Am Stat Assoc 53 (1958) 457-481
12. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemotherapy Rep 50 (1966) 163-170
13. Cox D.R. Regression models and life-tables (with discussions), series B. J R Statist Soc 34 (1972) 184-192
14. Peto R., Pike M.C., Armitage P., et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35 (1977) 1-39
15. Byar D. Identification of prognostic factors. In: Byse M.E., Staquet M.J., and Sylvester R.J. (Eds). Cancer clinical trials, methods and practice (1988), Oxford Medical Publications, Oxford, UK 423-443
16. Consigny Y., Modigliani R., Colombel J.F., et al. A simple biological score for predicting low risk of short-term relapse in Crohn's disease. Inflamm Bowel Dis 12 (2006) 551-557
17. Cox D.R., and Oakes D. Analysis of survival data (1984), Chapman and Hall, London 91
18. SPSS. Statistical package for social science, syntax reference guide (1994), SPSS Inc, Chicago
19. Fraser A.G., Orchard T.R., and Jewell D.P. The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30 year review. Gut 50 (2002) 485-489
20. Kim P.S., Zlatanic J., Korelitz B.I., et al. Optimum duration of treatment with 6-mercaptopurine for Crohn's disease. Am J Gastroenterol 94 (1999) 3254-3257
21. Vilien M., Dahlerup J.F., Munck L.K., et al. Randomized controlled azathioprine withdrawal after more than two years treatment in Crohn's disease: increased relapse rate the following year. Aliment Pharmacol Ther 19 (2004) 1147-1152
22. Holtmann M.H., Krummenauer F., Claas C., et al. Long-term effectiveness of azathioprine in IBD beyond 4 years: a European multicenter study in 1176 patients. Dig Dis Sci 51 (2006) 1516-1524
23. Present D.H., Meltzer S.J., Krumholz M.P., et al. 6-Mercaptopurine in the management of inflammatory bowel disease: short- and long-term toxicity. Ann Intern Med 111 (1989) 641-649
24. Weersma R.K., Peters F.T., Oostenbrug L.E., et al. Increased incidence of azathioprine-induced pancreatitis in Crohn's disease compared with other diseases. Aliment Pharmacol Ther 20 (2004) 843-850
25. Connell W.R., Kamm M.A., Ritchie J.K., et al. Bone marrow toxicity caused by azathioprine in inflammatory bowel disease: 27 years of experience. Gut 34 (1993) 1081-1085
26. Vernier-Massouille G., Cosnes J., Lemann M., et al. Nodular regenerative hyperplasia in patients with inflammatory bowel disease treated with azathioprine. Gut 56 (2007) 1404-1409
27. Fraser A.G., Orchard T.R., Robinson E.M., et al. Long-term risk of malignancy after treatment of inflammatory bowel disease with azathioprine. Aliment Pharmacol Ther 16 (2002) 1225-1232
28. Loftus Jr. E.V., Tremaine W.J., Habermann T.M., et al. Risk of lymphoma in inflammatory bowel disease. Am J Gastroenterol 95 (2000) 2308-2312
29. Kandiel A., Fraser A.G., Korelitz B.I., et al. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut 54 (2005) 1121-1125
30. Dayharsh G.A., Loftus Jr. E.V., Sandborn W.J., et al. Epstein-Barr virus-positive lymphoma in patients with inflammatory bowel disease treated with azathioprine or 6-mercaptopurine. Gastroenterology 122 (2002) 72-77
31. Beaugerie L., Carrat F., and Bouvier A. Cohorte nationale CESAME: données démographiques et médicales 2004-2005 pour 20919 patients. Gastroenterol Clin Biol 29 (2006) A154
32. Tougeron D., Mauillon J., and Tranvouez J.L. Severe varicella infection during treatment with infliximab for Crohn's disease. Gastroenterol Clin Biol 30 (2006) 1410-1413
33. Toruner M.L.J., Harmsen W.S., Zinsmeister A.R., et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology 134 (2008) 929-936
34. Kane S., Khatibi B., and Reddy D. Higher incidence of abnormal pap smears in women with inflammatory bowel disease. Am J Gastroenterol 103 (2008) 631-636
35. Brignola C., Campieri M., Bazzocchi G., et al. A laboratory index for predicting relapse in asymptomatic patients with Crohn's disease. Gastroenterology 91 (1986) 1490-1494
36. Cosnes J., Beaugerie L., Carbonnel F., et al. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 120 (2001) 1093-1099
37. Cosnes J., Carbonnel F., Beaugerie L., et al. Effects of cigarette smoking on the long-term course of Crohn's disease. Gastroenterology 110 (1996) 424-431
38. Friedman S. Medical therapy and birth outcomes in women with Crohn's disease: what should we tell our patients?. Am J Gastroenterol 102 (2007) 1414-1416
39. Nachury M., Lemann M., Cosnes J., et al. Efficacy of a second course of azathioprine in patients with Crohn's disease relapsing after azathioprine withdrawal. Gastroenterology 124 (2003) T1381
40. Vermaire S., Schreiber S., Sandborn W.J., et al. Determination of Harvey-Bradshaw index (HBi), definitions for response and remission using the CDAI data from PRECISE 1 and PRECISE 2. Gastroenterology 132 Suppl 2 (2007) 1280
41. Rutgeerts P., Diamond R.H., Bala M., et al. Scheduled maintenance treatment with infliximab is superior to episodic treatment for the healing of mucosal ulceration associated with Crohn's disease. Gastrointest Endosc 63 (2006) 433-442 464