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Z Gastroenterol. 2017 May;55(5):461-465. doi: 10.1055/s-0043-106310. Epub 2017 May 12.

Azathioprine allows glucocorticoid withdrawal - post hoc results of a prospective study in patients with inflammatory bowel diseases.

Author information

1
Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany.
2
Gemeinschaftspraxis - Endoskopiezentrum, Saarbrücken, Germany.
3
Gastroenterologische Gemeinschaftspraxis Minden, Germany.
4
Schwerpunktpraxis CED, Eschweiler, Germany.
5
Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany.
6
Center for Digestive Diseases, Cooperation of Internal Medicine Eppendorf, Hamburg, Germany.
7
Gastroenterologische Praxis, Herne, Germany.
8
MVZ Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany.
9
Medizinische Klinik für Gastroenterologie, Charite, CBF, Berlin, Germany.
10
Klinik für Innere Medizin IV, Universitätsklinikum Jena, Germany.

Abstract

Background Azathioprine is recommended as first-line immunosuppressant in patients with steroid-dependent inflammatory bowel diseases (IBDs). However, data on steroid withdrawal after induction therapy in IBD patients are sparse. Methods In this post-hoc analysis of a prospective multicenter study, we analyzed the proportion and clinical characteristics of 324 azathioprine-tolerant patients as to whether they could terminate the glucocorticoid therapy after initiation of treatment with azathioprine. Results Systemic steroid therapy was required in 190 patients (58.6 %) at baseline and in 40 patients (12.3 %) at the end of the follow-up period (p < 0.001). The median daily dose was 30 mg at baseline and 10 mg at follow-up. At baseline, only 122 patients (37.2 %) were advised to take at least the lowest recommended dose of 2 mg/kg per day. At follow-up, 221 patients (68.2 %) were prescribed at least the recommended maintenance dosage. Conclusion The majority of patients with thiopurine-naïve IBDs that needed systemic steroids at baseline were able to discontinue steroids after 3 - 6 months of azathioprine therapy. These data support the continued high value of azathioprine in the immunosuppressive therapy of IBD.

PMID:
28499322
DOI:
10.1055/s-0043-106310

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