Effect of azathioprine intolerance on outcomes of inflammatory bowel disease: a cross-sectional study

L, Lee; Gardezi, Anjum Syed; Santharam, Vidya; Boyd, Jason Timothy; Lanzon-Miller, S.

doi:10.1136/flgastro-2013-100348

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…We found no significant differences in the presence or absence of 5-ASA allergy and AZA intolerance or the history of AZA use (Table 2). In general, 5-ASA allergy and AZA intolerance are associated with poor prognosis, and in many such cases, make maintenance therapy difficult [20,21]. In the present study, these factors were not different between the maintenance and non-maintenance groups.…”

Section: Maintenance Rate At 52 Weeks and Patient Characteristicscontrasting

confidence: 46%

Remission Induction with Tacrolimus for Intractable Ulcerative Colitis: A Retrospective Study of Remission Rates, Maintenance at 52 Weeks, Drug-Specific Maintenance, and Safety

Ito¹,

Murasugi²,

Omori³

et al. 2023

Preprint

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Background and Aim: Tacrolimus is highly effective in intractable ulcerative colitis, but maintenance may be problematic. This study examined 52-week maintenance and adverse events. Methods: This retrospective study of patients who used tacrolimus from April 2009 to December 2021 (N = 136) examined remission induction rates and background factors in the remission (n = 108) and non-remission groups (n = 28); 52-week maintenance; drug-specific maintenance (azathioprine [n = 58] vs tacrolimus [n = 12] and vs biological product [Bio, n = 8]); and adverse events. Results: The mean observation period was 1230175 days. Remission occurred in 72.7%. Significant differences were observed in sex and endoscopic score (before treatment and 2 weeks after tacrolimus trough levels). Maintenance rate at 52 weeks was 61.6%; significant differences were observed in sex, hospitalization duration, and prednisolone during hospitalization (P < 0.05). Drug-specific 52-week maintenance was 67% with azathioprine, 54% with tacrolimus, and 37% with Bio. No tacrolimus-related serious adverse events occurred that led to discontinuation. Discussion: Remission was more common in women with improved endoscopic scores after tacrolimus trough levels and patients with improved endoscopic scores after tacrolimus therapy. Remission maintenance was more common in women with a long hospitalization at remission and high total steroid dose. Results suggest that treatment with adequate prednisolone use during the period with more inflammation may improve subsequent maintenance. Conclusions: In intractable ulcerative colitis, tacrolimus can induce remission even in patients who cannot use azathioprine for maintenance. Remission can be maintained with azathioprine, tacrolimus, or a Bio.

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Section: Maintenance Rate At 52 Weeks and Patient Characteristicscontrasting

confidence: 46%

Remission Induction with Tacrolimus for Intractable Ulcerative Colitis: A Retrospective Study of Remission Rates, Maintenance at 52 Weeks, Drug-Specific Maintenance, and Safety

Ito¹,

Murasugi²,

Omori³

et al. 2023

Preprint

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“…Azathioprine-associated GI intolerance 23,24 may also be called AZA-related dyspepsia 25 was observed in nearly half of our patients presenting with symptoms suggesting AP (29 of 55 patients with typical acute symptoms). This condition may have a negative impact on quality of life and may also lead to the discontinuation of the drug.…”

Section: Discussionmentioning

confidence: 80%

“…This condition may have a negative impact on quality of life and may also lead to the discontinuation of the drug. Shortly after the initiation of AZA, patients may experience abdominal discomfort and pain, nausea, and vomiting, which may also be seen during the course of AP and may lead to an incorrect diagnosis of AP 23,24 . At the first visit, within a week after the initiation of AZA, 10 of these patients discontinued the drug before their visit.…”

Section: Discussionmentioning

confidence: 99%

“…Shortly after the initiation of AZA, patients may experience abdominal discomfort and pain, nausea, and vomiting, which may also be seen during the course of AP and may lead to an incorrect diagnosis of AP. 23,24 At the first visit, within a week after the initiation of AZA, 10 of these patients discontinued the drug before their visit. The remaining 19 patients tolerated the drug after the dose reduction in their first visit.…”

Section: Discussionmentioning

confidence: 99%

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Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease

et al. 2021

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The aim of the study was to identify the frequency of azathioprine-induced acute pancreatitis (AZA-AP) and related factors.Methods: Seven hundred eighty-seven inflammatory bowel disease (IBD) patients on AZA therapy were retrospectively analyzed. Azathioprineinduced AP was diagnosed with positive imaging and/or an at least 3fold increased amylase level, in presence of typical abdominal pain. The AZA-AP group was compared with patients on AZA therapy with no history of pancreatitis and 4 numerical adjacent cases with the same diagnosis were selected (group B).Results: Fifty-four patients developed gastrointestinal symptoms (6.9%); however, only half of them (26 of 54) had pancreatitis, except 1, all within the first 2 months under AZA. When the AZA-AP group was compared with group B, only budesonide usage and active smoking were significantly more common in group A (46.2% vs 25%, P = 0.034, and 77% vs 51%, P = 0.017, respectively). Active smoking was the only independent risk factor for AZA-AP development (odds ratio, 3.208 [95% confidence interval, 1.192-8.632]). Conclusions:All IBD patients developed AZA-AP nearly all within the first 2 months. Azathioprine intolerance may be a hidden diagnosis in at least half of the patients with AZA-AP symptoms. All smoker IBD patients should be monitored closely for AZA-AP development.

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“… 38 In another study conducted by Lee et al with a mixed CD population of AZA tolerance and intolerance groups (26% intolerance), the need for surgery was reported to be 48% of the whole sample. 39 …”

Section: Resultsmentioning

confidence: 99%

Systematic review: treatment pattern and clinical effectiveness and safety of pharmaceutical therapies for Crohn’s disease in Europe

Lelli¹,

Nuhoho²,

Lee³

et al. 2016

CEG

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BackgroundAlthough many clinical trials have been conducted in treatments of Crohn’s disease (CD), whether the trial results were representative of daily practice needs to be supported by studies conducted in real-world settings.AimThis study aims to identify how CD is treated and what are the clinical effectiveness and safety of the pharmaceutical therapies of CD in real-world settings.MethodsA systematic literature review was conducted based on Medline®, Embase®, and Cochrane. All publications were assessed for title/abstract and full-text according to a predefined study protocol. Data were extracted and reported.ResultsA total of 1,998 publications were identified. Fifty studies including six publications reporting treatment pattern and 44 studies reporting clinical effectiveness and safety of pharmaceutical therapies in CD management in Europe were included. 5-Aminosalicylic acid and corticosteroids were reported to be used among 14%–74% of CD patients. Immunomodulators were used by 14%–25% and 29%–31% of CD patients as an initial and follow-up treatment, respectively. Biological therapies were used by 25%–33% of CD patients. A trend toward an increasing use of immunomodulators and biological therapies in Europe has been reported in recent years. Approximately 50% of patients achieved remission on immunomodulator or biologic treatment, although a relapse rate of up to 23% has been reported.ConclusionThere is a trend of treatment shift to immunomodulators and biologics in CD management. Clinical effectiveness of immunomodulators and biologics has been demonstrated, though with a lack of sustainability of the effectiveness.

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Effect of azathioprine intolerance on outcomes of inflammatory bowel disease: a cross-sectional study

Abstract: We conclude that azathioprine intolerance acts as a surrogate marker for patients with CD who in future have poorer symptom control. Azathioprine intolerance marks out a group of patients with CD in whom increased vigilance of symptom control and early escalation of treatment is required.

Cited by 5 publications

References 16 publications

Remission Induction with Tacrolimus for Intractable Ulcerative Colitis: A Retrospective Study of Remission Rates, Maintenance at 52 Weeks, Drug-Specific Maintenance, and Safety

Remission Induction with Tacrolimus for Intractable Ulcerative Colitis: A Retrospective Study of Remission Rates, Maintenance at 52 Weeks, Drug-Specific Maintenance, and Safety

Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease

Systematic review: treatment pattern and clinical effectiveness and safety of pharmaceutical therapies for Crohn’s disease in Europe

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Effect of azathioprine intolerance on outcomes of inflammatory bowel disease: a cross-sectional study

Abstract: We conclude that azathioprine intolerance acts as a surrogate marker for patients with CD who in future have poorer symptom control. Azathioprine intolerance marks out a group of patients with CD in whom increased vigilance of symptom control and early escalation of treatment is required.

Cited by 5 publications

References 16 publications

Remission Induction with Tacrolimus for Intractable Ulcerative Colitis: A Retrospective Study of Remission Rates, Maintenance at 52 Weeks, Drug-Specific Maintenance, and Safety

Remission Induction with Tacrolimus for Intractable Ulcerative Colitis: A Retrospective Study of Remission Rates, Maintenance at 52 Weeks, Drug-Specific Maintenance, and Safety

Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease

Systematic review: treatment pattern and clinical effectiveness and safety of pharmaceutical therapies for Crohn&rsquo;s disease in Europe

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Systematic review: treatment pattern and clinical effectiveness and safety of pharmaceutical therapies for Crohn’s disease in Europe