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
Mukesh Kumar Ranjan, Peeyush Kumar, Sudheer Kumar Vuyyuru, Bhaskar Kante, Sandeep K Mundhra, Rithvik Golla, Shubi Virmani, Raju Sharma, Peush Sahni, Prasenjit Das, Mani Kalaivani, Ashish Datt Upadhyay, Govind Makharia, Saurabh Kedia, Vineet Ahuja- Gastroenterology
- General Medicine
Abstract
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 is limited.
Method
We 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 to those started late (>2 years). Effectiveness defined as no requirement for hospitalization, anti-TNF agents, surgery, and minimum steroid requirement (≤ 1 steroid course in 2years) during follow-up.
Results
Nine-hundred eighty-eight (UC:720, CD:268) patients 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: HR:0.67, 95% 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 UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared to late initiation.