Rate and Predictors of Mucosal Healing in Ulcerative Colitis Treated with Thiopurines: Results of a Multicentric Cohort Study

Abstract

In UC, thiopurine monotherapy is associated with MH in 43.7% and HH in 38%.

Enduring Value of Thiopurines for Inflammatory Bowel Disease Therapy

“…Despite the lack of resolution of these issues for the purpose of this trial of thiopurines (fixed dose, 6-MP versus AZA, and lack of full access to all of the data with regard to histological healing), this study does provide renewed evidence for an unceasing benefit of thiopurines in the treatment of ulcerative colitis, whether alone or to supplement the response to biologicals should the clinical circumstances warrant [4,7].…”

“…In the current issue of Digestive Diseases and Sciences, Prieux-Klotz et al [4] provide new evidence that thiopurines by themselves retain importance in the maintenance therapy of ulcerative colitis, associated with mucosal healing in 43.7% and histological healing in 38%. In this study, the thiopurine dose was determined by the patient's weight, as was established in the original trial of 6-MP for Crohn's disease (CD) [1], although later experience revealed that further dose increases further augmented the clinical response, including mucosal healing.…”

“…Furthermore, in the study by Prieux-Klotz et al [4], only 2 of the 80 patients were treated with 6-MP, while the remaining 78 received AZA. Differences between AZA and 6-MP never were resolved.…”

“…Most researchers in inflammatory bowel disease now recognize the value of histological healing as well as endoscopic mucosal healing in assessing full response and remission [8,9]. Histologic healing was accomplished in 38% of the patients studied [4], which represents a minimum number given that only 47% of subjects were assessed for this outcome.…”

A Concise History of Thiopurines for Inflammatory Bowel Disease: From Anecdotal Reporting to Treat-to-Target Algorithms

“…has revealed that thiopurine monotherapy can achieve mucosal healing in 19% of the cases [46]. This data has now been implemented by the recent demonstration, in UC patients, that AZA monotherapy can obtain mucosal healing in 43%, and histological healing in 38% of the cases [47], meeting the unexpressed wishful thinking in Allen's paper [45], and implicating the added value that AZA monotherapy in UC can avoid or delay pre-emptive colectomy thanks to the control of otherwise unchecked dysplasia [48], achieving eventual chemoprevention [49]. Similar data are now freshly coming from Scandinavia, where the figures of thiopurine prescriptions, 7% between 1976 and 1990, had risen to 34% in 1991-2005, whereas the indication for colectomy got restrained consensually [50].…”