Mucosal healing for predicting clinical outcome in patients with ulcerative colitis using thiopurines in monotherapy

• Published in: European journal of internal medicine Vol. 22; no. 6; pp. 621 - 625
• Main Authors: López-Palacios, Natalia, Mendoza, Juan L, Taxonera, Carlos, Lana, Raquel, López-Jamar, José Miguel Esteban, Díaz-Rubio, Manuel
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-12-2011
• Subjects: Adolescent; Adult; Azathioprine; Azathioprine - administration & dosage; Clinical remission; Cohort Studies; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - pathology; Colitis, Ulcerative - physiopathology; Colonoscopy; Female; Follow-Up Studies; Humans; Immunosuppressive Agents - administration & dosage; Internal Medicine; Intestinal Mucosa - drug effects; Intestinal Mucosa - pathology; Intestinal Mucosa - physiology; Male; Mercaptopurine; Mercaptopurine - administration & dosage; Middle Aged; Mucosal healing; Predictive Value of Tests; Treatment Outcome; Ulcerative colitis; Wound Healing - drug effects; Wound Healing - physiology; Young Adult; European Crohn's and Colitis Organization; MCV; FDA; TNFα; tumor necrosis factor α; TPMT; IBD; UC; SD; Clinical remission; ulcerative colitis; MH; Food and Drug Administration; mucosal healing; erythrocyte sedimentation rate; CD; MP; ESR; 5-aminosalicylic acid; AZA; azathioprine; Crohn's disease; ECCO; inflammatory bowel disease; thiopurine methyltransferase; mercaptopurine; 5-ASA; mean corpuscular volume; standard deviation; Mucosal healing; Azathioprine; Mercaptopurine; Ulcerative colitis
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2011.06.017

Abstract Background Mucosal healing (MH) has emerged as a desirable treatment goal for patients with ulcerative colitis (UC). Currently little is known about the efficacy of using thiopurine immunosuppressants in monotherapy to achieve and maintain long-term MH in UC. This study analyzes the efficacy and the clinical impact of MH in patients with UC responded to thiopurine immunosuppressants in the long term. Methods An open , observational, cohort study in 20 patients with UC had been in clinical remission in monotherapy with thiopurine immunosuppressants for at least 1 year. MH was assessed by endoscopy. The patients according to the Mayo Endoscopic Score (0 vs 1 and 2), were followed until the end of the study or patient relapse. (according to Truelove and Witts criteria). Results Mean treatment time was 5.4 years. Twelve (60%) patients presented a Mayo Endoscopic Score of 0. A total of 18 patients were followed up for a median of 27.1 months. After endoscopy, 4 patients (22.2%) presented relapse, with a mean time of 27.5 months for a score ≥ 1 (95% CI; 18.2–36.8) versus 54.3 months for a score = 0 (95% CI 47.2–61.3) (p = 0.032). Conclusions This study shows the efficacy of thiopurine immunosuppressants in achieving mucosal healing in patients who respond to thiopurine immunosuppressants in the long term. We also observe the presence of endoscopy activity is not a rare event in this group of patients and is a predictor of early relapse.