Impact of thiopurines and anti-tumour necrosis factor therapy on hospitalisation and long-term surgical outcomes in ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammatory condition affecting the large bowel and is associated with a significant risk of both requirement for surgery and the need for hospitalisation. Thiopurines, and more recently, anti-tumour necrosis factor (aTNF) therapy have been used successfully to induce clinical remission. However, there is less data available on whether these agents prevent long-term colectomy rates or the need for hospitalisation. The focus of this article is to review the recent and pertinent literature on the long-term impact of thiopurines and aTNF on long-term surgical and hospitalisation rates in UC. Data from population based longitudinal research indicates that thiopurine therapy probably has a protective role against colectomy, if used in appropriate patients for a sufficient duration. aTNF agents appear to have a short term protective effect against colectomy, but data is limited for longer periods. Whereas there is insufficient evidence that thiopurines affect hospitalisation, evidence favours that aTNF therapy probably reduces the risk of hospitalisation within the first year of use, but it is less clear on whether this effect continues beyond this period. More structured research needs to be conducted to answer these clinically important questions.

Frailty Predicts Morbidity after Colectomy for Ulcerative Colitis

“…2 In majority of the cases, medical management with immunosuppressive agents and antitumor necrosis factor (TNF-a) biologic therapy has been successful in limiting exacerbations and maintaining clinical remission. 3,4 However, in approximately 15 per cent of patients, despite medical intervention, the disease can remain refractory or progress to fulminant disease with severe life-threatening consequences requiring surgical intervention. 5 Colectomy for UC is definitively curative, and although this intervention introduces new inconveniences and challenges for the patient, it can significantly improve quality of life in those with severe disease.…”