P375. Efficacy, safety, impact on natural history of long-term treatment with thiopurines in Crohn's disease patients. A single center experience


A. Calafiore1, P. Gionchetti1, G. Vitali2, C. Calabrese1, R. Brugnera1, G. Liguori1, M.C. Valerii3, R. Tambasco1, G. Poggioli2, M. Campieri1, F. Rizzello1

1University of Bologna, Clinical Medicine, Bologna, Italy; 2University of Bologna, Emergency surgery, general surgery and organ transplantation, Bologna, Italy; 3University of Bologna, Experimental Biology, Bologna, Italy



Background: Thiopurines are widely used for maintaining remission in Crohn's disease (CD), but only few papers explore the long-term efficacy of AZA. We evaluated the efficacy and safety of patients treated with AZA in a 5 years follow up period.

Methods: From October 2000 to December 2010 196 consecutive patients [mean age (range 13–65); location: ileo-colonic 57.5%, colonic 11.7%, upper GI 26.2%; perianal disease: 67%; EIMs: 25%; indication: steroid-dependance (28%), disabling disease (26%) and prevention of postoperative relapse (46%)] treated with thiopurines were prospectively followed for a minimum period of 5 years. Primary end-point was the maintenance of remission free of steroids; Secondary end-points were safety, prevention of post-op relapse.

Results: After the first year 32% of steroid-dependent patients were in steroid-free remission, 36% were non-responders and 32% were intolerant. Remission rate remained substantially constant along the observation period. In patients with disabling disease, the steroid-free remission rate was 57% after 1 year, 40% at 3 years and 26% at 5 years. Same remission rate was found in patients with surgically-induced remission. During 5 years-follow up no serious adverse events were observed. Patients with a previous surgery were able to avoid a new resection during the observational period compared with patients without previous surgery (24% vs 12.2%, p = 0.045).

Conclusions: Thiopurine are effective in maintaining steroid-free long-term remission in steroid-dependent and aggressive CD. Thiopurine treatment is able to avoid a new surgery in previously resected patients.