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Jornal Português de Gastrenterologia

versão impressa ISSN 0872-8178


SOUSA, Ana Lúcia et al. Azathioprine in inflammatory bowel disease: Predictors of sustainded long-term response. J Port Gastrenterol. [online]. 2014, vol.21, n.4, pp.147-154. ISSN 0872-8178.

Introduction: Azathioprine (AZA) is an option for maintenance therapy in Inflammatory Bowel Disease (IBD). However, the factors which influence or predict its response are poorly understood. Aim: Evaluate the predictive factors for a successful long-term therapeutic response of AZA. Methods: Retrospective analysis of all patients with IBD followed up in our hospital treated with AZA (2-2.5 mg/Kg/day) due to steroid dependent or resistent disease or, in Crohn disease (CD), due to fistulizing behavior or post-surgery. We recorded the type of disease (DC/ ulcerative colitis (UC), indeterminate IBD), clinical parameters, laboratory parameters (LP) - WBC, CRP, hemoglobin, platelets and MCV - before and after 3 months of treatment, as well as concomitante usage of 5-ASA and steroids. The treatment was considered effective when patients maintained control of the disease by clinical/endoscopic criteria, with continued maintainance of AZA or cessation of therapy after 3 months of treatment, and without escalation of therapy. We excluded patients who show intolerance to AZA in the first 3 months and patients treated concomitantly with biological agents. Results: 72 patients (37 women and 35 men); mean age 38.0±13.8 years; 35 patients with CD, 34 with UC and 3 with indeterminate IBD. The average duration of treatment with AZA was 35.1±30.6 months. AZA was effective in 48 patients (66.7%). The age at onset of AZA predicts therapeutic sucess (R = 0.303, p = 0.019). The sex, type of disease and LP before treatment did not correlate with efficacy. The LP after 3 months of therapy correlated with therapeutic sucess in the long-term: WBC (r = -0.295, p = 0.013), CRP (r = -0.332, p = 0.005), hemoglobin (r = 0.307, p = 0.010), platelets (r = -0.360, p = 0.003) and MCV (r = 0.255, p = 0.047). In combination, LP predict the efficacy of treatment (R = 0.517, p = 0.005). There is also an association between the location of UC (r = -0.381, p = 0.026), as well as the duration of concurrent treatment with 5-ASA (r = 0.258, p = 0.029) and the suspension of steroids (r = 0.265, p = 0.04) with the efficacy of the treatment. Conclusion: AZA proved to be an effective treatment in the majority of patients with IBD. The old age of onset of the therapy and LP at 3 months were predictive of a sustained response of AZA.

Palavras-chave : Inflammatory bowel disease; Azathioprine; Treatment efficacy.

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