Effectiveness and safety of azathioprine for inflammatory pouch disorders: results from the RESERVO study of GETECCU.

Background: The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders. Objective: To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders. Design: This was a retrospective and multicentre study. Methods: We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI). Results: In all, 63 patients were included [54% males; median age, 49 (28-77) years]. The therapy was used to treat pouchitis (n = 37) or Crohn's disease of the pouch (n = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11-55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2-4) to 1 (range 0-3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy. Conclusion: Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option.

Long-Term Outcomes of Biological Therapy in Crohn's Disease Complicated With Internal Fistulizing Disease: BIOSCOPE Study From GETECCU.

INTRODUCTION: The prevalence of penetrating complications in Crohn's disease (CD) increases progressively over time, but evidence on the medical treatment in this setting is limited. The aim of this study was to evaluate the effectiveness of biologic agents in CD complicated with internal fistulizing disease. METHODS: Adult patients with CD-related fistulae who received at least 1 biologic agent for this condition from the prospectively maintained ENEIDA registry were included. Exclusion criteria involved those receiving biologics for perianal disease, enterocutaneous, rectovaginal, anastomotic, or peristomal fistulae. The primary end point was fistula-related surgery. Predictive factors associated with surgery and fistula closure were evaluated by multivariate logistic regression and survival analyses. RESULTS: A total of 760 patients from 53 hospitals (673 receiving anti-tumor necrosis factors, 69 ustekinumab, and 18 vedolizumab) were included. After a median follow-up of 56 months (interquartile range, 26-102 months), 240 patients required surgery, with surgery rates of 32%, 41%, and 24% among those under anti-tumor necrosis factor, vedolizumab, or ustekinumab, respectively. Fistula closure was observed in 24% of patients. Older patients, ileocolonic disease, entero-urinary fistulae, or an intestinal stricture distal to the origin of the fistula were associated with a higher risk of surgery, whereas nonsmokers and combination therapy with an immunomodulator reduced this risk. DISCUSSION: Biologic therapy is beneficial in approximately three-quarters of patients with fistulizing CD, achieving fistula closure in 24%. However, around one-third still undergo surgery due to refractory disease. Some patient- and lesion-related factors can identify patients who will obtain more benefit from these drugs.

[Benzodiazepine use in a sample of patients on a treatment program with opiate derivatives (PTDO)]. / Consumo de benzodiacepinas en una muestra de pacientes en Programa de Tratamiento con Derivados Opiáceos (PTDO).

OBJECTIVES: Benzodiazepines (BZ) are widely prescribed drugs, but their use is controversial in patients who present a disorder caused by substance use/abuse, due to the risk of tolerance and abuse/dependence. The purpose of this work is to determine the levels of BZ use in patients treated with methadone and to compare them with findings from the current literature. METHODOLOGY: a sample of 43 patients was selected; inclusion criterion was being on the PTDO (treatment program with opiate derivatives) at the UAD (Drug-dependence unit) in Monforte de Lemos (Lugo-Spain). Demographic and use variables were analyzed. Data collection and subsequent analysis were carried out using the statistical program SPSS 12.0. RESULTS: 46.5% of the patients take BZ, and of these, 60% are over age 45. The most widely used of these is alprazolam (p<0.001), and 70% take just one active ingredient. The main prescriber is the general practitioner, and the most frequent indication is insomnia. DISCUSSION AND CONCLUSIONS: BZ-use data and their relationship to time spent on methadone are similar to those of other published studies. Despite the recommendation to use long half-life BZ in patients with substance abuse disorders, it is striking that in the case studied here the most widely prescribed type is alprazolam.

Consumo de benzodiacepinas en una muestra de pacientes en Programa de Tratamiento con Derivados Opiáceos (PTDO) / Benzodiazepine use in a sample of patients on a treatment program with opiate derivatives (PTDO)

Objetivos: Las benzodiacepinas (BZD) son fármacos ampliamente prescritos, pero su utilización es controvertida en pacientes que presentan un trastorno por uso/abuso de sustancias debido al riesgo de tolerancia y abuso/dependencia. El objetivo de este trabajo es determinar la utilización de benzodiacepinas en los pacientes a tratamiento con metadona y compararlo con la literatura existente. Metodología: Se ha seleccionado una muestra de 43 pacientes cuyos criterios de inclusión fueron estar en PTDO en la Unidad Asistencial de Drogodependencias (UAD) de Monforte. Se analizaron variables demográficas y de consumo. La recogida de datos y el posterior análisis se ha realizado mediante el programa estadístico SPSS 12.0.Resultados: El 46,5% toman benzodiacepinas y de éstos el 60% es mayor de 45 años. La más usada es alprazolam (p < 0,001). El 70%, toman un único principio activo. El principal presciptor es el médico de cabecera y la indicación más frecuente es el insomnio. Discusión y conclusiones: Los datos de consumo de BZD y su relación con el tiempo de permanencia en metadona son similares a los de otros estudios publicados. A pesar de la recomendación de utilizar en pacientes con trastorno por abuso de sustancias BZD de vida media larga, resulta llamativo que en nuestro caso la más prescrita sea alprazolam (AU)

Objectives: Benzodiazepines (BZ) are widely prescribed drugs, but their use is controversial in patients who present a disorder caused by substance use/abuse, due to the risk of tolerance and abuse/dependence. The purpose of this work is to determine the levels of BZ use in patients treated with methadone and to compare them with findings from the current literature. Methodology: a sample of 43 patients was selected; inclusion criterion was being on the PTDO (treatment program with opiate derivatives) at the UAD (Drug-dependence unit) in Monforte de Lemos (Lugo-Spain). Demographic and use variables were analyzed. Data collection and subsequent analysis were carried out using the statistical program SPSS 12.0. Results: 46.5% of the patients take BZ, and of these, 60% are over age 45.The most widely used of these is alprazolam (p < 0.001), and 70% take just one active ingredient. The main prescriber is the general practitioner, and the most frequent indication is insomnia. Discussion and Conclusions; BZ-use data and their relationship to timespent on methadone are similar to those of other published studies. Despite the recommendation to use long half-life BZ in patients with substance abuse disorders, it is striking that in the case studied here the most widely prescribed type is alprazolam (AU)

El deber de no abandonar al paciente / Non abandonement: a central obligation for physicians

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