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Adding Thiopurine After Loss of Response to Infliximab Versus Early Combination in Treating Crohn's Disease: A Retrospective Study.
- Source :
-
Digestive diseases and sciences [Dig Dis Sci] 2021 Sep; Vol. 66 (9), pp. 3124-3131. Date of Electronic Publication: 2020 Sep 13. - Publication Year :
- 2021
-
Abstract
- Background: Although combining thiopurine with infliximab (IFX) is considered to improve the clinical efficacy of IFX when treating Crohn's disease (CD), it also increases the risk of adverse events (AEs). We compared the efficacy and safety of delayed thiopurine addition after loss of response (LOR) to IFX with the efficacy and safety of an earlier combination of thiopurine and IFX.<br />Methods: This retrospective study analyzed patients with CD who started IFX as a first-line biologic at Kyushu University Hospital between June 2002 and July 2018. Patients were assigned to either the early-combination (EC) group, who started IFX and thiopurine simultaneously, or the late-combination (LC) group, who were treated with IFX alone until they developed LOR. We compared the cumulative IFX continuation rates and AE incidence between the two groups.<br />Results: One hundred seventy-six patients were enrolled in this study; 49 were enrolled in the EC group, and 127 were enrolled in the LC group. Disease activity at baseline did not significantly differ between the groups, nor did the cumulative IFX continuation rates differ between the groups (P = 0.30); however, the AE rate was significantly higher in the EC group than in the LC group (38.7% vs. 21.2%; P = 0.02). The severe AE rate was also higher in the EC group than in the LC group (18.3% vs 3.1%; P = 0.001).<br />Conclusion: Considering the risk-benefit balance, delayed addition of thiopurine after LOR to IFX might be an alternative strategy when using IFX to treat CD.<br /> (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)
- Subjects :
- Adult
Antimetabolites administration & dosage
Antimetabolites adverse effects
Biological Products administration & dosage
Biological Products adverse effects
Drug Monitoring methods
Drug Synergism
Female
Humans
Japan epidemiology
Male
Retrospective Studies
Risk Assessment
Treatment Outcome
Azathioprine administration & dosage
Azathioprine adverse effects
Crohn Disease diagnosis
Crohn Disease drug therapy
Crohn Disease epidemiology
Drug Therapy, Combination adverse effects
Drug Therapy, Combination methods
Drug-Related Side Effects and Adverse Reactions diagnosis
Drug-Related Side Effects and Adverse Reactions etiology
Infliximab administration & dosage
Infliximab adverse effects
Mercaptopurine administration & dosage
Mercaptopurine adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1573-2568
- Volume :
- 66
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Digestive diseases and sciences
- Publication Type :
- Academic Journal
- Accession number :
- 32920717
- Full Text :
- https://doi.org/10.1007/s10620-020-06600-z