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Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease: relapse and recapture rates, with predictive factors in 237 patients.

Kennedy NA, Kalla R, Warner B, Gambles CJ, Musy R, Reynolds S, Dattani R, Nayee H, Felwick R, Harris R, Marriott S, Senanayake SM, Lamb CA, Al-Hilou H, Gaya DR, Irving PM, Mansfield J, Parkes M, Ahmad T, Cummings JR, Arnott ID, Satsangi J, Lobo AJ, Smith M, Lindsay JO, Lees CW - Aliment. Pharmacol. Ther. (2014)

Bottom Line: Relapse rate at 12 months was significantly higher in CD than UC (P = 0.035).Elevated CRP at withdrawal was associated with higher relapse rates at 12 months for CD (P = 0.005), while an elevated white cell count was predictive at 12 months for UC (P = 0.007).Thiopurine withdrawal in the context of sustained remission is associated with a 1-year moderate-to-severe relapse rate of 23% in Crohn's disease and 12% in ulcerative colitis.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.

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Survival analysis of relapse following withdrawal of thiopurines for sustained remission stratified by predictive factors in Crohn's disease (a) and ulcerative colitis (b).
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fig02: Survival analysis of relapse following withdrawal of thiopurines for sustained remission stratified by predictive factors in Crohn's disease (a) and ulcerative colitis (b).

Mentions: Disease location and the most significant univariable laboratory parameters (haemoglobin, white cell count and CRP) were included in multivariable models for CD and UC. The Cox proportional hazards method was used to create a model to assess the contribution of each variable to risk of relapse. After backwards stepwise exclusion of variables that did not contribute to the model, WCC and CRP remained for CD, and only WCC remained for UC (Table5). Thresholds were then found to allow stratification of patients at higher and lower risk, and to allow creation of survival curves (Figure2).


Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease: relapse and recapture rates, with predictive factors in 237 patients.

Kennedy NA, Kalla R, Warner B, Gambles CJ, Musy R, Reynolds S, Dattani R, Nayee H, Felwick R, Harris R, Marriott S, Senanayake SM, Lamb CA, Al-Hilou H, Gaya DR, Irving PM, Mansfield J, Parkes M, Ahmad T, Cummings JR, Arnott ID, Satsangi J, Lobo AJ, Smith M, Lindsay JO, Lees CW - Aliment. Pharmacol. Ther. (2014)

Survival analysis of relapse following withdrawal of thiopurines for sustained remission stratified by predictive factors in Crohn's disease (a) and ulcerative colitis (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232866&req=5

fig02: Survival analysis of relapse following withdrawal of thiopurines for sustained remission stratified by predictive factors in Crohn's disease (a) and ulcerative colitis (b).
Mentions: Disease location and the most significant univariable laboratory parameters (haemoglobin, white cell count and CRP) were included in multivariable models for CD and UC. The Cox proportional hazards method was used to create a model to assess the contribution of each variable to risk of relapse. After backwards stepwise exclusion of variables that did not contribute to the model, WCC and CRP remained for CD, and only WCC remained for UC (Table5). Thresholds were then found to allow stratification of patients at higher and lower risk, and to allow creation of survival curves (Figure2).

Bottom Line: Relapse rate at 12 months was significantly higher in CD than UC (P = 0.035).Elevated CRP at withdrawal was associated with higher relapse rates at 12 months for CD (P = 0.005), while an elevated white cell count was predictive at 12 months for UC (P = 0.007).Thiopurine withdrawal in the context of sustained remission is associated with a 1-year moderate-to-severe relapse rate of 23% in Crohn's disease and 12% in ulcerative colitis.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.

Show MeSH
Related in: MedlinePlus