Risk of colectomy in patients with ulcerative colitis under thiopurine treatment
Por:
Canas-Ventura, A, Marquez, L, Ricart, E, Domenech, E, Gisbert, JP, Garcia-Sanchez, V, Marin-Jimenez, I, Rodriguez-Moranta, F, Gomollon, F, Calvet, X, Merino, O, Garcia-Planella, E, Vazquez-Romero, N, Esteve, M, Iborra, M, Gutierrez, A, Vera, M, Andreu, M
Publicada:
1 oct 2014
Resumen:
Background and Aims: Little is known about the risk factors of colectomy in patients with ulcerative colitis (UC) under thiopurine treatment. The aim of the study was to determine the prevalence and the predictive risk factors of colectomy in an extensive cohort of patients with UC treated with thiopurines in Spain.
Methods: Among 5753 UC patients, we identified those diagnosed between 1980 and 2009 and treated with azathioprine or mercaptopurine (AZA/MP). We analyzed the age at diagnosis, familial history of IBD, extraintestinal manifestations (ElMs), disease extent, smoking status and treatment requirements (AZA/MP, cyclosporine (CsA) or anti-TNF alpha). Colectomies for dysplasia or cancer were excluded. Survival analysis and Cox proportional hazard regression were performed. Results were reported as hazard ratios (HR) with 95% Cl.
Results: Among the 1334 cases included, 119 patients (8.9%) required colectomy after a median time of 26 months (IQR 12-42) after AZA/MP initiation. Independent predictors of colectomy were: Extensive UC (HR 1.7, 95% Cl: 1.1-2.6), ElMs (HR 1.5, 95% CI: 1.0-2.4), need for antiTNF alpha (HR 2.3, 95% CI: 1.5-3.4) and need for CsA (HR 2.4, 95% CI: 1.6-3.7). Patients requiring early introduction of AZA/MP had an increased risk of colectomy with a HR of 4.9 (95% CI: 3.2-7.8) when AZA/MP started in the first 33 months after UC diagnosis.
Conclusions: Nearly one-tenth of patients with UC under thiopurines require colectomy. Extensive UC, ElMs, need for CsA or anti-TNF alpha ever and an early need for AZA/MP treatment were associated with a higher risk of colectomy. These risk factors of colectomy could help to stratify risk in further controlled studies in UC. (C) 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Canas-Ventura, A:
Hosp Mar, IMIM, Med Res Inst, Dept Gastroenterol, Barcelona, Spain
Marquez, L:
Hosp Mar, IMIM, Med Res Inst, Dept Gastroenterol, Barcelona, Spain
Ricart, E:
Hosp Clin Barcelona, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Domenech, E:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Gisbert, JP:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IP, Madrid, Spain
Garcia-Sanchez, V:
Univ Cordoba, Inst Maimonides Invest Biomed Cordoba IMIBIC, Hosp Univ Reina Sofia, Digest Syst Serv, Cordoba, Spain
Marin-Jimenez, I:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Rodriguez-Moranta, F:
Bellvitge Hosp, Lhospitalet De Llobregat, Spain
Gomollon, F:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Clin Univ, Inst Invest Sanitaria Aragon, Zaragoza, Spain
Calvet, X:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Corp Sanitaria Univ Parc Tauli, Serv Malalties Digest, Sabadell, Spain
Univ Autonoma Barcelona, Dept Med, E-08193 Barcelona, Spain
Merino, O:
Hosp Cruces, Baracaldo, Spain
Garcia-Planella, E:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Vazquez-Romero, N:
Hosp Gen Univ Elche, Elche, Spain
Esteve, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Univ Mutua Terrassa, Barcelona, Spain
Iborra, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Univ La Fe, Valencia, Spain
Gutierrez, A:
Hosp Gen Univ Alacant, Alicante, Spain
Vera, M:
Hosp Univ Puerta Hierro, Madrid, Spain
Andreu, M:
Hosp Mar, IMIM, Med Res Inst, Dept Gastroenterol, Barcelona, Spain
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