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Thiopurines Maintenance Therapy in Children With Ulcerative Colitis: A Multicenter Retrospective Study
Firas Abu Hanna1, Ohad Atia2, Anat Yerushalmy Feler3
1From the Pediatric Gastroenterology Unit, Emek Medical Centre, Afula, Israel.
Insights
Thiopurines effectively induce corticosteroid-free remission in over half of pediatric ulcerative colitis patients within a year. This study suggests thiopurines can be a valuable treatment option before considering biologics for children with UC.
Area of Science:
- Pediatric Gastroenterology
- Immunomodulatory Therapies
Background:
- Ulcerative colitis (UC) in children requires effective treatment.
- Thiopurines are used for pediatric UC, but safety and efficacy data are limited.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of thiopurine treatment in pediatric UC patients.
- To determine the rate of corticosteroid-free remission and need for rescue therapy.
Main Methods:
- Retrospective review of 133 children (2-18 years) with UC treated with thiopurines.
- Primary outcome: corticosteroid-free clinical remission at 52 weeks without rescue therapy (infliximab, calcineurin inhibitors, or colectomy).
Main Results:
- 56% of patients achieved corticosteroid-free remission at 52 weeks without rescue therapy.
- Long-term maintenance of remission off rescue therapy was observed in 83% at 1 year, decreasing to 37% by 4 years.
- Predictors for remission were not identified in this cohort.
Conclusions:
- Thiopurines demonstrate efficacy in achieving clinical remission in pediatric UC patients.
- The findings support considering thiopurines as a treatment option prior to biologic therapy in pediatric UC.
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 conducted a retrospective review of children (2-18 years) with UC treated with thiopurines between January 2008 and January 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 (interquartile range 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-aminosalicylates and 72 (54%) with CS. Sixty patients (45%) received thiopurines as 1st 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 weeks later without the need for rescue therapy. Thiopurines are effective in pediatric UC and could be considered prior to biologics.
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