Early Azathioprine Therapy Is No More Effective Than Placebo for Newly Diagnosed Crohn's Disease

Panés, Julián; López-Sanromán, Antonio; Bermejo, Fernando; García–Sánchez, Valle; Esteve, María; Torres, Yolanda; Domènech, Eugeni; Piqueras, Marta; Gómez‐García, María; Gutiérrez, Ana; Taxonera, Carlos; Sans, Miquel

doi:10.1053/j.gastro.2013.06.009

Cited by 225 publications

(156 citation statements)

References 25 publications

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“…However, using an immunosuppressant agent first with or without a corticosteroid is completely in line with major CDtreatment recommendations and guidelines 15,19,35 . This practice is not in contradiction to the increasing body of evidence, that anti-TNF based strategies are more effective in achieving crucial CD endpoints 18 and the recently published data on thiopurines, revealing no benefit of an early introduction regarding the primary endpoints 16,36 . Although the top-down approach has been shown to be superior in inducing remission, reducing the need for steroids and achieving mucosal healing, there was no clinical benefit regarding long-term remission rates beyond 52 weeks between early combined immunosuppression (top-down) and conventional management (bottom-up) groups 17 .…”

Section: Discussionmentioning

confidence: 93%

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

Vavricka

Radivojevic²,

Manser³

et al. 2014

Digestive and Liver Disease

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BACKGROUND: In recent years several trials have addressed treatment challenges in Crohn's disease. Clinical trials however, represent a very special situation. AIMS: To perform a cross-sectional survey among gastroenterologists on the current clinical real life therapeutic approach focussing on the use of biologics. METHODS: A survey including six main questions on clinical management of loss of response, diagnostic evaluation prior to major treatment changes, preference for anti-tumour necrosis factor (TNF) agent, (de-)escalation strategies as well as a basic section regarding personal information was sent by mail to all gastroenterologists in Switzerland (n=318). RESULTS: In total, 120 questionnaires were analysed (response rate 37.7%). 90% of gastroenterologists in Switzerland use a thiopurine as the first step-up strategy (anti-TNF alone 7.5%, combination 2.5%). To address loss of response, most physicians prefer shortening the interval of anti-TNF administration followed by dose increase, switching the biologic and adding a thiopurine. In case of prolonged remission on combination therapy, the thiopurine is stopped first (52.6%) after a mean treatment duration of 15.7 months (biologic first in 41.4%). CONCLUSIONS: Everyday clinical practice in Crohn's disease patients appears to be incongruent with clinical data derived from major trials. Studies investigating reasons underlying these discrepancies are of need to optimize and harmonize treatment.

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Section: Discussionmentioning

confidence: 93%

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

Vavricka

Radivojevic²,

Manser³

et al. 2014

Digestive and Liver Disease

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“…These drugs allow corticosteroid withdrawal and maintain clinical remission at the first 2 years of treatment in 44%-80% of pediatric patients [97][98][99]. The only pediatric CD randomized, placebo controlled trial reported by Markowitz et al [97] failed to demonstrate any benefit of 6-MP on growth parameters compared to placebo after 18 months of follow-up.…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

Shamir¹

2014

J Clin Cell Immunol

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Growth retardation is a common complication of pediatric inflammatory bowel disease (IBD), which may have long term effects on final adult height and carries significant social and psychological implications. Etiology may be multifactorial including undernutrition, metabolic dysregulation, inflammatory impact on hormonal growth axis and the effect of drugs such as glucocorticoids. Control of disease activity and minimizing the need for corticosteroid therapy are necessary measures in order to facilitate normal growth. However, in many cases these strategies are not sufficient. Currently, there is inconsistent evidence regarding the efficacy of available therapeutic agents to induce long-term effect on growth. The new era of biologic therapies which carries a greater potential to achieve mucosal healing, holds promise for better growth even in children with severe growth impairment. It becomes apparent that prompt recognition of growth impairment combined with aggressive tailored therapeutic approach may offer the best chance for catch-up growth. This review will discuss the definition, prevalence and mechanism of growth retardation in children with IBD and highlight the specific benefits of current therapeutic strategies.

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“…First, the primary endpoints for these two studies demonstrate that early "top down" therapy with thiopurine therapy is not more effective that placebo or conventional therapy in adults with newly diagnosed CD (although some subgroups of patients may have benefited). 19,20 These results cast some doubt as to whether the results of a small pediatric study have any relevance for adult patients with newly diagnosed CD. 17 Second, we should acknowledge that the most recent…”

mentioning

confidence: 99%

“…In this issue of Gastroenterology contains the results of two such studies, reported by Cosnes and Panes. 19,20 Cosnes (for the GETAID group) reported on an open-label randomized trial in 147 adult patients with newly diagnosed CD (less than 6 months) and risk factors for disabling disease (patients were considered at high risk of disabling disease based on the presence of at least two of the following criteria: age < 40 years, active perianal lesions, and corticosteroid use within 3 months of diagnosis) recruited at 24 French centers. 19 The patients were randomized to receive early immunosuppression with AZA 2.5 mg/kg/day or conventional management.…”

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confidence: 99%

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Is There Still a Role for Thiopurines in Crohn's Disease?

Rogler

Sandborn

2013

Gastroenterology

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Early Azathioprine Therapy Is No More Effective Than Placebo for Newly Diagnosed Crohn's Disease

Cited by 225 publications

References 25 publications

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

Is There Still a Role for Thiopurines in Crohn's Disease?

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