Assuntos
Humanos , Meio Ambiente , Meio Ambiente e Saúde Pública , Nações Unidas , Mudança Climática , Saúde GlobalRESUMO
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 are 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 with those started late [>2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up. RESULTS: A total of 988 [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%; pâ =â 0.92] or CD [76% and 66% vs 72% and 51%, pâ =â 0.32]. Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45-0.97; pâ =â 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32-6.71; pâ =â 0.008], steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26-5.68; pâ =â 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27-0.80; pâ =â 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 with late initiation.
Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Purinas , Compostos de Sulfidrila , Humanos , Masculino , Adulto , Estudos Retrospectivos , Pontuação de Propensão , Doenças Inflamatórias Intestinais/tratamento farmacológico , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Esteroides/uso terapêuticoRESUMO
No abstract available.
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No abstract available.
