Rate and Predictors of Endoscopic Mucosal Healing in Biologic Naive Patients with Inflammatory Bowel Disease by Azathioprine Treatment: A Real World, 10 Years’ Experience from a Single Centre in Turkey

Abstract

Background There is increasing evidence that endoscopic mucosal healing (EMH) is a key target in inflammatory bowel disease (IBD) therapy. However, there is limited evidence of EMH rates with conventional IBD therapy outside of Western population groups. Aım To evaluate the role of azathioprine (AZA) in inducing EMH in IBD patients. Methods Patients with inflammatory bowel disease were evaluated in terms of endoscopic mucosal healing and the incidence of surgical interventions during the azathioprine treatment between 1995 to 2014. Results A total of 120 inflammatory bowel disease patients were enrolled. Endoscopic mucosal healing was found in 37% patients with inflammatory bowel disease (42% in chronic ulcerative colitis and 33% in Crohn’s disease). Male gender had a negative impact on the efficacy of azathioprine (P<0.05). Responder inflammatory bowel disease patients were older (age at the IBD diagnose) than the nonresponder (P<0.05). Azathioprine therapy reduced the number of the surgical interventions (P<0.05). Conclusıon We showed that azathioprine therapy significantly induced endoscopic mucosal healing in biologic naïve patients with active inflammatory bowel disease as well as decreasing the surgical interventions, with negative predictive factors identified by a younger age at IBD presentation and male gender.

Calcium/calmodulin–dependent protein kinase IV (CaMKIV) activation contributes to the pathogenesis of experimental colitis via inhibition of intestinal epithelial cell proliferation

“…Our results presented here suggest that continued regeneration of the intestinal epithelium is a key factor in combating intestinal inflammation (95)(96)(97). Likewise, clinical evidence has illustrated that complete mucosal healing of the intestinal epithelium is associated with long-term remissions, decreased risk of hospitalizations and surgery, and improved quality of life in patients with IBD (98)(99)(100)(101)(102). Thus, new therapeutics targeting signaling pathways that enhance the health of the intestinal epithelium would prove beneficial in promoting mucosal healing during intestinal inflammation.…”

Rate and Predictors of Endoscopic Mucosal Healing in Biologic Naive Patients with Inflammatory Bowel Disease by Azathioprine Treatment: A Real World, 10 Years’ Experience from a Single Centre in Turkey

“…Overall, there are inconsistencies in EMH rates between different studies that are likely to relate to heterogeneity in study design, drug dosing and disease severity [1,4,5,20,21,14]. These differences preclude direct study and population comparisons, but EMH rates identified in our Turkish IBD cohort seem comparable to other (predominately Western) populations.…”

“…Azathioprine (AZA) is a purine analogue that competitively inhibits the biosynthesis of purine nucleotides, and is widely available as an immunosuppressant at relatively low cost [5][6][7][8][9]. Side-effects of therapy can include leucopenia, pancreatitis, fever and rash, which can sometimes limit their use in clinical practice.…”

“…The study was approved by the ethics committee, and data was collected on patients treated with AZA from Inflammatory Bowel Disease clinics. Eligible patients were at least 18 years of age, and had established IBD for at least 3 months; with a Crohn's Disease Activity Index (CDAI) score of 220 to 450 points, and severely active UC as defined according to the total Mayo score [5]. Patients were excluded if they had started AZA at another hospital, or if AZA was used primarily for another disease indication.…”

“…Endoscopic mucosal healing (EMH) is now taken as a key treatment-goal in IBD management; achieving a positive modification in the natural history of IBD, and better outcomes with regard to steroid-free remission, surgery and hospitalization [2][3][4][5]. Current medical strategies for moderate to severe IBD include the use of corticosteroids, immunosuppressants (such as Azathioprine (AZA) and 6-Mercaptopurine) and biologic therapies.…”