Anette Mertz-Nielsen, Klaus Theede, Lise Lotte Gluud, Marianne Kiszka-Kanowitz

Affiliates

Gastro Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.

Abstract

Introduction
The aim of this study was to evaluate the long-term effect of thiopurine treatment in a prospective enrolled cohort of UC patients when treatment is optimised using measurements of 6-thioguanine nucleotide (6TGN) or when intolerant changing therapy to either 6MP, or the combination of AZA/ALLO or 6MP/ALLO
Design
We obtained long-term data from two randomized controlled studies evaluating low dose optimized thiopurine therapy consisting of azathioprine/allopurinol (L-AZA/ALLO) combination or AZA monotherapy (AZA) in 66 patients who were thiopurine naïve and had moderate-to-severe (UC). After completion of the randomized trials, treatment was adjusted according to adverse effect as well as metabolites; the treatment was changed if levels of 6-TGN were lower than 350 pmol/8*108 RBC. Patients originally treated with AZA were switched to AZA/ALLO, 6-mercaptopurine (6-MP) or 6-MP/ALLO. Patients treated with AZA/ALLO were switched to 6-MP or 6-MP/ALLO.
Results
Two patients who turned out to have Crohn’s disease were excluded from the analysis and 2 patients were lost to follow-up. Our analyses included 62 patients (31 treated with AZA first and 31 with AZA/ALLO first). 67 % tolerated initial treatment (7 AZA and 28 L-AZA/ALLO) which increased to 58 (94%) of all patients after the intervention. In 41 patients with primary response, 38/41 (93%) patients remained in steroid and biologics free remission without surgery after a median follow-up time of 52 months. 4 patients were intolerant and 17 did not respond to optimization and this group were more likely to undergo colectomy (OR 16.36; 95% CI 3.08 to 87.03).
Conclusion
Optimized thiopurine therapy seems to be an effective long-term treatment for patients with UC and can be tolerated by most of the patients.

Poster or oral