Significant Differences Between Crohn’s Disease and Ulcerative Colitis Regarding the Impact of Body Mass Index and Initial Disease Activity on Responsiveness to Azathioprine: Results from a European Multicenter Study in 1,176 Patients

Abstract

In a survey comprising 1,176 patients with inflammatory bowel disease (IBD) we recently showed that azathioprine (AZA) beyond 4 years is beneficial in ulcerative colitis (UC) patients and in a subset of Crohn's disease (CD) patients. Here, we show for the first time that azathioprine responsiveness depends on body mass index (BMI). The relationship is reciprocal in UC and CD, with a better outcome in UC patients with a BMI<25 and in CD patients with a BMI>25. These observations are particularly interesting considering the evolving concept of a relationship between fatty metabolism and immune regulation. Additionally, we show that CD patients, but not UC patients, respond better to AZA when it is started in clinical remission. This observation may support data favouring a "hit hard and early" regime in CD. Finally, we were able to demonstrate a decrease in the incidence of CD-related complications requiring surgery through treatment with AZA.

Prevalence of metabolic syndrome is comparable between inflammatory bowel disease patients and the general population

“…Furthermore, a case report suggested that reducing body weight might also contribute to decreasing disease activity in UC [32]. Holtmann et al [33] have also recently shown improved outcomes after azathioprine treatment in UC patients with BMI maintained under 25, suggesting the benefit of body weight control in IBD patients. The results from our study emphasize the importance of lifestyle modifications, such as regular exercise, body weight reduction, and smoking cessation, not only in the general population, but also in IBD patients.…”

Long‐term oral mesalazine adherence and the risk of disease flare in ulcerative colitis: nationwide 10‐year retrospective cohort from the veterans affairs healthcare system

“…25 This study used the ACD as a surrogate for disease severity. Higher daily dose of mesalazine (4.8 g/d) is indicated in moderate disease, whereas lower dose (2.4 g/d) is enough for mild disease.…”

Health care costs and their predictors of inflammatory bowel diseases in Germany

“…Recently, Holtmann et al [36] were able to show that in UC, patients with a BMI of \ 25 respond better to azathioprine than patients with a BMI [ 25. In CD, the response to azathioprine is independent from the BMI during treatment with azathioprine. This is slightly different from our findings.…”