Smoking status and response to thiopurines in steroid-dependent inflammatory bowel disease

Domènech, Eugeni; Carrión, Sílvia; García‐Planella, Esther; Mañosa, Míriam; Gordillo, Jordi; Concepción, Mar; Guarner, Carlos; Cabré, Eduard

doi:10.1002/ibd.21456

Cited by 20 publications

(14 citation statements)

References 34 publications

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“…who demonstrated that surgical risk is only increased in smokers not undergoing immunosuppressive therapy. Domenech et al . similarly observed smoking did not influence stricturing or penetrating disease behaviour when patients were medicated with thiopurines.…”

Section: Discussionsupporting

confidence: 91%

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Lunney

Kariyawasam

Wang

et al. 2015

Aliment Pharmacol Ther

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Summary Background Smoking demonstrates divergent effects in Crohn's disease (CD) and ulcerative colitis (UC). Smoking frequency is greater in CD and deleterious to its disease course. Conversely, UC is primarily a disease of nonsmokers and ex‐smokers, with reports of disease amelioration in active smoking. Aim To determine the prevalence of smoking and its effects on disease progression and surgery in a well‐characterised cohort of inflammatory bowel diseases (IBD) patients. Methods Patients with smoking data of the Sydney IBD Cohort were included. Demographic, phenotypic, medical, surgical and hospitalisation data were analysed and reported on the basis of patient smoking status. Results 1203 IBD patients were identified comprising 626 CD and 557 UC with 6725 and 6672 patient‐years of follow‐up, respectively. CD patients were more likely to smoke than UC patients (19.2% vs. 10.2%, P < 0.001). A history of smoking in CD was associated with an increased proportional surgery rate (45.8% vs. 37.8%, P = 0.045), requirement for IBD‐related hospitalisation (P = 0.009) and incidence of peripheral arthritis (29.8% vs. 22.0%, P = 0.027). Current smokers with UC demonstrated reduced corticosteroid utilisation (24.1% vs. 37.5%, P = 0.045), yet no reduction in the rates of colectomy (3.4% vs. 6.6%, P = 0.34) or hospital admission (P = 0.25) relative to nonsmokers. Ex‐smokers with UC required proportionately greater immunosuppressive (36.2% vs. 26.3%, P = 0.041) and corticosteroid (43.7% vs. 34.5%, P = 0.078) therapies compared with current and never smokers. Conclusions This study confirms the detrimental effects of smoking in CD, yet failed to demonstrate substantial benefit from smoking in UC. These data should encourage all patients with IBD to quit smoking.

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Section: Discussionsupporting

confidence: 91%

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Lunney

Kariyawasam

Wang

et al. 2015

Aliment Pharmacol Ther

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“…More recently, Domènech et al . found that smoking does not influence the development of complicated phenotypes in a population receiving thiopurine treatment . In accordance with these findings, we have recently published a large cross‐sectional study supported by the Spanish working group on Crohn′s and colitis, which found no main differences between current smokers and nonsmokers with respect to disease behaviour and complications; smoking, however, was an independent predictor for need of anti‐TNF therapy …”

Section: Introductionsupporting

confidence: 79%

Smoking does influence disease behaviour and impacts the need for therapy in Crohn′s disease in the biologic era

Nunes

Etchevers

Domènech

et al. 2013

Aliment Pharmacol Ther

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“…The UC cohort had a much higher incidence of deranged LFTs than the CD cohort and this has not been previously noted. Previous authors have reported that smoking is a risk factor for azathioprine intolerance,13 and although these data were not collected and we cannot comment on this finding, this study indicates that female sex and age 50–70 years are additional further risk factors.…”

Section: Discussioncontrasting

confidence: 68%

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

Gardezi

Santharam

et al. 2013

Frontline Gastroenterol

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Smoking status and response to thiopurines in steroid-dependent inflammatory bowel disease

Abstract: Active smoking does not influence the response to thiopurines in steroid-dependent IBD, but may decrease the likelihood of drug tolerance.

Cited by 20 publications

References 34 publications

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Smoking prevalence and its influence on disease course and surgery in Crohn's disease and ulcerative colitis

Smoking does influence disease behaviour and impacts the need for therapy in Crohn′s disease in the biologic era

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

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