RESUMO
Background Azathioprine is recommended as first-line immunosuppressant in patients with steroid-dependent inflammatory bowel diseases (IBDs). However, data on steroid withdrawal after induction therapy in IBD patients are sparse. Methods In this post-hoc analysis of a prospective multicenter study, we analyzed the proportion and clinical characteristics of 324 azathioprine-tolerant patients as to whether they could terminate the glucocorticoid therapy after initiation of treatment with azathioprine. Results Systemic steroid therapy was required in 190 patients (58.6â%) at baseline and in 40 patients (12.3â%) at the end of the follow-up period (pâ<â0.001). The median daily dose was 30âmg at baseline and 10âmg at follow-up.âAt baseline, only 122 patients (37.2â%) were advised to take at least the lowest recommended dose of 2âmg/kg per day. At follow-up, 221 patients (68.2â%) were prescribed at least the recommended maintenance dosage. Conclusion The majority of patients with thiopurine-naïve IBDs that needed systemic steroids at baseline were able to discontinue steroids after 3â-â6 months of azathioprine therapy. These data support the continued high value of azathioprine in the immunosuppressive therapy of IBD.
Assuntos
Azatioprina , Doenças Inflamatórias Intestinais , Azatioprina/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores , Doenças Inflamatórias Intestinais/tratamento farmacológico , Estudos ProspectivosRESUMO
BACKGROUND AND AIMS: Azathioprine [AZA] is recommended for maintenance of steroid-free remission in inflammatory bowel disease IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors. METHODS: We studied 510 IBD patients [338 Crohn's disease, 157 ulcerative colitis, 15 indeterminate colitis] with initiation of AZA treatment in a prospective multicentre registry study. Acute pancreatitis was diagnosed in accordance with international guidelines. RESULTS: AZA was continued by 324 [63.5%] and stopped by 186 [36.5%] patients. The most common cause of discontinuation was nausea [12.2%]. AZA-induced pancreatitis occurred in 37 patients [7.3%]. Of these: 43% were hospitalised with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections; 24% had vomiting; and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis [p < 0.0002] in univariate and multivariate analyses. CONCLUSIONS: AZA-induced acute pancreatitis is a common adverse event in IBD patients, but in this study had a mild course in all patients. Smoking is the most important risk factor.