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dc.contributor.authorStournaras, Evangelosen
dc.contributor.authorQian, Wendien
dc.contributor.authorPappas, Apostolosen
dc.contributor.authorHong, You Yien
dc.contributor.authorShawky, Rashaen
dc.contributor.authorUK IBD BioResource Investigators,en
dc.contributor.authorRaine, Timen
dc.contributor.authorParkes, Milesen
dc.contributor.authorUK IBD Bioresource Investigators,en
dc.date.accessioned2020-07-20T23:30:43Z
dc.date.available2020-07-20T23:30:43Z
dc.date.issued2021-04en
dc.identifier.issn0017-5749
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/308170
dc.description.abstractAbstract Objective. Thiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery. Design. Outcomes were assessed in 11,928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biologic therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation, and comparison of surgery rates in patients tolerant or intolerant of thiopurines. Results. Using 68,132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared to 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR=0.47, 95% CI=0.43-0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (hazard ratio [HR] 2.44 p<0.0001); with a more modest impact on need for surgery in CD (HR = 1.23, p=0.0015). Conclusion. Thiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherBMJ
dc.rightsAll rights reserved
dc.subjectUK IBD BioResource Investigatorsen
dc.subjectUK IBD Bioresource Investigatorsen
dc.titleThiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn's disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource.en
dc.typeArticle
prism.endingPage686
prism.issueIdentifier4en
prism.publicationDate2021en
prism.publicationNameGuten
prism.startingPage677
prism.volume70en
dc.identifier.doi10.17863/CAM.55265
dcterms.dateAccepted2020-07-12en
rioxxterms.versionofrecord10.1136/gutjnl-2019-320185en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2021-04en
dc.contributor.orcidStournaras, Evangelos [0000-0002-9885-0673]
dc.contributor.orcidRaine, Tim [0000-0002-5855-9873]
dc.contributor.orcidParkes, Miles [0000-0002-6467-0631]
dc.identifier.eissn1468-3288
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMEDICAL RESEARCH COUNCIL (MR/M00533X/1)
pubs.funder-project-idNational Association for Colitis and Crohn's Disease (NACC) (MR/M00533X/1)
cam.orpheus.successMon Oct 12 07:31:11 BST 2020 - Embargo updated*
cam.orpheus.counter11*
rioxxterms.freetoread.startdate2020-10-01


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