Azathioprine allows glucocorticoid withdrawal – post hoc results of a prospective study in patients with inflammatory bowel diseases

Abstract

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 (58.6 %) at baseline and in 40 patients (12.3 %) at the end of the follow-up period (p < 0.001). The median daily dose was 30 mg at baseline and 10 mg at follow-up. At baseline, only 122 patients (37.2 %) were advised to take at least the lowest recommended dose of 2 mg/kg per day. At follow-up, 221 patients (68.2 %) 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 3 – 6 months of azathioprine therapy. These data support the continued high value of azathioprine in the immunosuppressive therapy of IBD.

Zusammenfassung

Hintergrund Azathioprin wird als Erstinien-Immunsuppressivum bei Patienten mit steroidabhängigen chronisch entzündlichen Darmerkrankungen (CED) empfohlen. Es existieren jedoch kaum Daten über die Möglichkeit des Absetzens von Glukokortikoiden nach der Induktionstherapie mit Azathioprin.

Methoden In dieser posthoc-Analyse einer prospektiven multizentrischen Studie analysierten wir den Anteil und die klinischen Charakteristika von 324 Azathioprin-toleranten Patienten hinsichtlich der Frage, ob sie die nach Therapiebeginn mit Azathioprin die Glukokortikoidtherapie beenden konnten.

Ergebnisse Eine systemische Steroidtherapie war bei 190 Patienten (58,6 %) zu Beginn und bei 40 Patienten (12,3 %) am Ende der Nachbeobachtungszeit (p < 0,001) erforderlich. Die mittlere Tagesdosis betrug 30 mg zu Beginn und 10 mg bei Nachuntersuchung. Zu Studienbeginn wurde 122 Patienten (37,2 %) empfohlen, mindestens die empfohlene Mindestdosis von 2 mg/kg pro Tag zu nehmen. Bei der Nachuntersuchung wurde hingegen bereits 221 Patienten (68,2 %) die empfohlene Mindestdosis verordnet.

Schlussfolgerung Die meisten Thiopurin-naiven CED-Patienten, die zu Studienbeginn eine systemische Glukokortikoidtherapie benötigten, konnten diese nach 3 – 6 Monaten Azathioprin-Einnahme absetzen. Diese Daten unterstützen die weiterhin hohe Wertigkeit von Azathioprin in der immunsuppressiven Therapie der CED.

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - Steroidtherapie - chronisch entzündliche Darmerkrankung

Keywords

crohn’s disease - ulcerative colitis - steroid therapy - inflammatory bowel disease

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