Tolerance and efficacy of azathioprine in pediatric Crohnʼs disease

Abstract

AZA is efficacious in maintaining remission in pediatric CD patients, but to a lesser extent than previously suggested. The majority of patients who are in steroid-free remission at 12 months remained in prolonged remission. Overall tolerance of AZA was excellent.

Repeated exclusive enteral nutrition in the treatment of paediatric Crohn's disease: predictors of efficacy and outcome

“…Similar observations were made by Riello et al reviewing their experience with thiopurines: paediatric CD patients who were in remission at 1 year usually remained relapse-free during subsequent follow-up. 21 In our cohort, this observation holds true even in thiopurine-na€ ıve patients and may indicate a more generally valid clinical experience.…”

“…In a small randomised controlled trial (RCT) in selected children with steroid-induced remission, Markowitz et al reported relapse rates after 18 months as low as~10% of patients with 6-mercaptopurin therapy compared to~50% on placebo. 20 These results have never been confirmed neither in clinical practice in children 21 nor in a recent RCT in adults. 22 Clinical trials in paediatric CD are warranted for evidence-based recommendation on immunomodulatory maintenance therapy after induction therapy with EEN.…”

Time to Relapse in Children with Crohn’s Disease Treated with Azathioprine and Nutritional Therapy or Corticosteroids

“…Meanwhile, our results were comparable to Riello [34] in the setting of early AZA use in both groups. A recent pediatric study comparing long-term outcomes of CS vs. EEN induction therapy with ''early'' use of thiopurines (\6 months from diagnosis) documented reduction in linear growth failure, CS dependency, and better primary sustained response to IFX, but similar combined CS-/IFXfree remission and surgical resection rates [35].…”

“…Several recently published studies comparing long-term outcomes of EEN and CS have assessed and compared rates of remission between groups (Fig. 4 in ''Appendix'') [15][16][17][18][19][32][33][34][35].…”

“…However, predictors of long-term AZA efficacy in sustaining remission in the pediatric literature are scarce. Riello et al [34] did not find any predictors from baseline data in patients treated by AZA since the time of diagnosis. In the previously mentioned study by Levine et al [18], the authors found that normal C-reactive protein (CRP) and steroid-free remission at week 12 were predictive factors for remission at week 52.…”