Thiopurines Maintenance Therapy in Children With Ulcerative Colitis: A Multicenter Retrospective Study

Abstract

Background and aims: Thiopurines are an established treatment for pediatric ulcerative colitis (UC).However, data regarding safety and efficacy are lacking.We aimed to determine short and long-term outcome following thiopurines use in children with UC. Methods: We conducteda retrospective review of children (2-18 years) with UC treated with thiopurines between Jan 2008 and Jan 2019 at 7 medical centers in Israel. The primary outcome was corticosteroid (CS)-free clinical remission at week 52 following thiopurines initiation without the need for rescue therapy (infliximab, calcineurin inhibitors, or colectomy). Results: A total of 133 children were included (median age at diagnosis of 12.4 (IQR 11.0-15.8) years, 30 (23%) left sided colitis, 113 (85%) with moderate or severe disease at diagnosis).At diagnosis 58 patients (44%) were treated with 5-aminosalicylatesand 72 (54%) with CS. Sixty patients (45%) received thiopurines as 1 st line maintenance therapy. Seventy-four patients(56%) had CS-free clinical remission at week 52 without rescue therapy. Predictors of clinical remission were not identified.In a sub-analysis among patients with steroid-responsive moderate to severe UC, 59 (55%) patients achieved this outcome. The likelihood of remaining free of rescue therapy among thiopurines-treated patients was 83%, 62%, 45% and 37% at 1, 2, 3 and 4 years, respectively. Conclusion: More than half of children with UC starting thiopurines without previous or concomitant biologic therapy have CS-free clinical remission at 52 week later without the need for rescue therapy. Thiopurines are effective in pediatric UC and could be considered prior to biologics.

Evolving Landscape of Paediatric Inflammatory Bowel Disease: Insights from a Decade-Long Study in North-East Slovenia on Incidence, Management, Diagnostic Delays, and Early Biologic Intervention

“…In a recent study by Abu Hana at al. [46], thiopurines demonstrated both safety and efficacy, with 21% of children with CD and 27% of those with UC exhibiting positive outcomes. These findings support the continued consideration of thiopurines as a viable treatment option for selected children with mild-to-moderate inflammatory bowel disease, particularly in cases without identifiable risk factors for a complicated disease course.…”