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Prognosis of Patients with Ulcerative Colitis in Sustained Remission After Thiopurines Withdrawal

Moreno-Rincón, Estefanía MD*; Benítez, José Manuel MD*; Serrano-Ruiz, Francisco Javier MD*; Vázquez-Morón, Juan María MD; Pallarés-Manrique, Héctor MD, PhD; Herrera-Justiniano, José Manuel MD; Leo-Carnerero, Eduardo MD; Gómez-García, María Rosario MD, PhD§; Cabello-Tapia, María José MD, PhD§; Castro-Fernández, Manuel MD, PhD; Rojas-Feria, María MD, PhD; Castro-Laria, Luisa MD; Argüelles-Arias, Federico MD, PhD; Camargo-Camero, Raquel MD, PhD**; Alcaín-Martínez, Guillermo MD, PhD**; Iglesias-Flores, Eva MD*; García-Sánchez, Valle MD, PhD*

doi: 10.1097/MIB.0000000000000400
Original Clinical Articles

Background: The ideal length of treatment with thiopurines in patients with ulcerative colitis (UC) in sustained remission remains unknown. It is widely accepted that the drug withdrawal is associated with a worse outcome. The aim of this study was to analyze the outcome after this withdrawal and to identify predictors of relapse.

Methods: A multicenter and retrospective study was designed. A total of 102 patients with UC who discontinued thiopurines in a situation of sustained remission were included. All the patients were followed up until last revision or until relapse (understood as the occurrence of signs and symptoms of UC that required a rescue treatment).

Results: After thiopurines withdrawal, overall relapse was recorded in 32.35% of the patients: 18.88% in the first year, 36.48% in the third, and 43.04% in the fifth year after withdrawal. On multivariate analysis, predictors of relapse were the time from diagnosis of UC until the starting of thiopurines (hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.01–1.02; P = 0.039), the number of relapses before the withdrawal (HR, 1.3; 95% CI, 1.01–1.66; P = 0.029), pancolitis (HR, 5.01; 95% CI, 1.95–26.43; P = 0.028), the duration of treatment with thiopurines (HR, 0.15; 95% CI, 0.03–0.66; P = 0.013) and the situation of biological remission at withdrawal (HR, 0.004; 95% CI, 0.0001–0.14; P = 0.002).

Conclusions: The withdrawal of thiopurines in patients with UC, although in sustained remission, is related to a high relapse rate. Clinical variables such as the extent of the disease, the duration of treatment or time from diagnosis to the start of thiopurines should be considered before stopping these drugs.

Article first published online 28 April 2015.

*Department of Gastroenterology, IMIBIC (Maimónides Institute of Biomedical Research of Córdoba), University Hospital Reina Sofía, Córdoba, Spain;

Department of Gastroenterology, University Hospital Juan Ramón Jiménez, Huelva, Spain;

Department of Gastroenterology, University Hospital Virgen del Rocío, Sevilla, Spain;

§Department of Gastroenterology, University Hospital Virgen de las Nieves, Granada, Spain;

Department of Gastroenterology, University Hospital Nuestra Señora de Valme, Sevilla, Spain;

Department of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain; and

**Department of Gastroenterology, University Hospital Virgen de la Victoria, Málaga, Spain.

Reprints: Estefanía Moreno-Rincón, MD, Department of Gastroenterology, University Hospital Reina Sofía, Avenida Menéndez Pidal s/n, 14004 Córdoba, Spain (e-mail: estefania.mr.86@gmail.com).

The authors have no conflicts of interest to disclose.

All the authors are current members of the “Grupo Andaluz de Trabajo en Enfermedad Inflamatoria Intestinal.”

Received January 26, 2015

Accepted February 17, 2015

© Crohn's & Colitis Foundation of America, Inc.
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