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J Gastroenterol Hepatol. 2013 Oct;28(10):1595-9. doi: 10.1111/jgh.12263.

Addition of thiopurines can recapture response in patients with Crohn's disease who have lost response to anti-tumor necrosis factor monotherapy.

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1
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Gastroenterology, National University Hospital, Singapore.

Abstract

BACKGROUND AND AIM:

Anti-tumor necrosis factor (TNF) antibodies are effective in maintaining remission in Crohn's disease. However, a significant proportion of patients lose response to these agents with time. This study aimed to determine whether the introduction of a thiopurine in patients who have lost response to anti-TNF monotherapy results in regained response.

METHODS:

Five patients (four males; aged 22-38 years) with active Crohn's disease, who had an initial response to anti-TNF therapy but had lost response, were commenced on azathioprine or mercaptopurine at standard doses while continuing anti-TNF therapy. All had previously failed thiopurine therapy prior to starting anti-TNF treatment.

RESULTS:

All patients experienced improved clinical symptoms within 2-6 months, with benefit sustained over a mean follow-up of 19 months. Two patients with an elevated C-reactive protein at the time of thiopurine addition demonstrated a fall in C-reactive protein. Colonoscopy before and after thiopurine addition in four patients showed improvement in all, with mucosal healing achieved in two. No adverse effects of treatment were noted.

CONCLUSIONS:

Addition of a thiopurine in patients who have lost response to anti-TNF monotherapy is an effective strategy to recapture response even if the patient has previously failed thiopurine therapy. Thiopurines may reduce immunogenicity or act synergistically with anti-TNF therapy.

KEYWORDS:

Crohn's disease; anti-TNF; inflammatory bowel disease; loss of response; thiopurine; thiopurines

PMID:
23662928
DOI:
10.1111/jgh.12263
[Indexed for MEDLINE]
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