Article

Chebli JM, Gaburri PD, De Souza AF, et al. Long-term results with azathioprine therapy in patients with corticosteroid-dependent Crohn's disease: open-label prospective study

Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
Journal of Gastroenterology and Hepatology (Impact Factor: 3.5). 03/2007; 22(2):268-74. DOI: 10.1111/j.1440-1746.2006.04393.x
Source: PubMed

ABSTRACT

A substantial number of patients with Crohn's disease (CD) become dependent on steroids after induction therapy. Treatment with azathioprine (AZA) may be beneficial in such patients. The present open-label study evaluated the long-term safety and efficacy of AZA in steroid-dependent CD patients.
Adult patients with steroid-dependent CD were enrolled for AZA therapy over a 7-year period. The average dose of AZA was 2.0-3.0 mg/kg per day, adjusted according to clinical response and occurrence of adverse effects. Steroid therapy was tapered off according to a predefined schedule. Long-term outcome and adverse reactions were evaluated.
Sixty-nine patients were prospectively included. Steroid-free remission was achieved in 68-81% of patients, partial response in 14.5-27.3% and failure to respond to AZA in 4-15.9% over the initial 48 months. However, the rate of wean from steroid therapy decreased to 53-60% while the rate of failure increased from 6.7% to 17.6% after this period. A breakthrough of symptoms during continuous AZA therapy was common, particularly after 48 months on AZA. The mean leukocyte count at the end of 12 months of therapy was significantly lower in patients who achieved complete response on AZA than in the non-responders (5197 +/- 1250 cells/mm(3) vs 8340 +/- 1310 cells/mm(3), respectively; P < 0.01). Azathioprine was relatively well-tolerated and the incidence of serious adverse effects was small.
Azathioprine was relatively safe and moderately effective for long-term maintenance of steroid-free clinical remission in corticosteroid-dependent CD patients. Patients were more successfully weaned from prednisone treatment, and clinical remission was more often maintained during the first 48 months of AZA therapy. A significant decrease in the white blood cell count at the end of 12 months on AZA was the single factor associated with weaning from steroid dependence.

Download full-text

Full-text

Available from: Pedro Gaburri, Jul 30, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chinese unknown word extraction is an important problem for Chinese language processing. There are troublesome difficulties in the problem. First, almost any Chinese character can either represent a word or be a part of other words. Secondly, there is no blank between Chinese words for identifying the boundaries. Although some approaches have been proposed, there are some drawbacks in these methods. Here, we present and develop a method to extract Chinese unknown words more efficiently and precisely. It retains efficiency and accuracy even though the size of document set is small for training. It can also extract the unknown words occur rarely. Based on these advantages, it is very practical for real applications.
    Preview · Conference Paper · Nov 2003
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The clinical course of Crohn's disease (CD) is characterized by unpredictable phases of disease activity and quiescence. The majority of CD patients experience mild to moderate disease or are in clinical remission over significant periods during the course of their disease. These patients can be treated conservatively with 5-aminosalicylates or budesonide depending on the disease location. Those patients with more severe forms of the disease who require corticosteroids should be treated more aggressively with early introduction of immunomodulator and/or biologic therapy, which may help to prevent the complications associated with CD. It has been suggested that therapies directed at mucosal healing may favorably modify the natural history of CD. As newer, more effective medications become available and new therapeutic approaches are introduced (top-down therapy), mucosal healing, and not solely clinical remission, may well become the preferred treatment objective.
    Preview · Article · Nov 2007
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the quality of care for a hospital based-cohort of patients with inflammatory bowel disease (IBD) from East China according to the current practice guidelines. A retrospective review was conducted, involving 177 patients with IBD admitted to Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University between June 2000 and June 2006. Data regarding demographic and clinical characteristics as well as medical therapy including use of oral aminosalisylates, topical therapy, corticosteroid agents, immunomodulatory agents (such as azathioprine) at admission and outpatient clinic visit were analyzed. A total of 177 eligible patients were evaluated in this study, including 71 patients with Crohn's disease (CD) and 106 with ulcerative colitis (UC). All were the Han nationality Chinese with active disease at baseline. All the 106 patients with ulcerative colitis received optimal doses of aminosalisylate while 27 of 68 (39.7%) patients with ileal or colonic CD received the suboptimal doses of aminosalisylate. The incidence of suboptimal dose of aminosalisylate was significantly higher in CD patients with small intestine involvement only (52.8% vs 25.0%, P=0.019). Thirty-one (54.4%) patients with active distal or left-sided ulcerative colitis received topical therapy, and 27.8% of patients suffering from severe inflammatory bowel disease did not receive oral or intravenous steroid therapy. Among the 51 patients for whom thiopurine was indicated, only 10 (19.6%) received immunomodulatory agents, and more than half of the 8 patients received a suboptimal dose of azathiopurine with no attempt to increase its dosage. The quality of care for IBD patients can be further improved. A suboptimal dose of aminosalicylate is used in treatment of patients with CD, especially in those with small intestine involved only. Topical mesalazine is inadequately used in patients with distal or left-sided colitis. Oral or intravenous steroid therapy is not used in some patients with severe IBD. Use of immunomodulatory medication is limited. Larger prospective studies are needed to investigate the quality of care for patients with IBD to establish our own evidence-based guidelines.
    Preview · Article · Feb 2008 · World Journal of Gastroenterology
Show more