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Gastroenterology. 2000 Jun;118(6):1018-24.

Azathioprine for maintenance of remission in Crohn's disease: benefits outweigh the risk of lymphoma.

Author information

  • 1Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. jlewis@cceb.med.upenn.edu

Abstract

BACKGROUND & AIMS:

Azathioprine is a commonly used and effective treatment for maintenance of remission for patients with steroid-dependent Crohn's disease (CD). However, azathioprine therapy is associated with an increased risk of non-Hodgkin's lymphoma. The objective of this analysis was to determine the impact of azathioprine therapy on survival and quality-adjusted life expectancy after accounting for both the benefits of therapy and potential increased risk of lymphoma.

METHODS:

A decision analysis using a Markov model depicting the natural history of alternative management strategies for maintenance of remission in patients with CD was performed.

RESULTS:

In the base-case analysis, treatment of CD patients with a steroid-induced remission with azathioprine resulted in an average increase in life expectancy of 0.04 years and 0.05 quality-adjusted years. The incremental gain in life expectancy decreased with increasing patient age and increasing risk of lymphoma.

CONCLUSIONS:

Therapy with azathioprine to preserve remission in patients with CD results in increased quality-adjusted life expectancy. This increase was greatest in young patients who have the lowest baseline risk of non-Hodgkin's lymphoma and who have the greatest life expectancy in the absence of a CD-related death.

PMID:
10833475
[PubMed - indexed for MEDLINE]
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