PMID- 32920717
OWN - NLM
STAT- MEDLINE
DCOM- 20210929
LR  - 20210929
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 66
IP  - 9
DP  - 2021 Sep
TI  - Adding Thiopurine After Loss of Response to Infliximab Versus Early Combination 
      in Treating Crohn's Disease: A Retrospective Study.
PG  - 3124-3131
LID - 10.1007/s10620-020-06600-z [doi]
AB  - BACKGROUND: Although combining thiopurine with infliximab (IFX) is considered to 
      improve the clinical efficacy of IFX when treating Crohn's disease (CD), it also 
      increases the risk of adverse events (AEs). We compared the efficacy and safety 
      of delayed thiopurine addition after loss of response (LOR) to IFX with the 
      efficacy and safety of an earlier combination of thiopurine and IFX. METHODS: 
      This retrospective study analyzed patients with CD who started IFX as a 
      first-line biologic at Kyushu University Hospital between June 2002 and July 
      2018. Patients were assigned to either the early-combination (EC) group, who 
      started IFX and thiopurine simultaneously, or the late-combination (LC) group, 
      who were treated with IFX alone until they developed LOR. We compared the 
      cumulative IFX continuation rates and AE incidence between the two groups. 
      RESULTS: One hundred seventy-six patients were enrolled in this study; 49 were 
      enrolled in the EC group, and 127 were enrolled in the LC group. Disease activity 
      at baseline did not significantly differ between the groups, nor did the 
      cumulative IFX continuation rates differ between the groups (P = 0.30); however, 
      the AE rate was significantly higher in the EC group than in the LC group (38.7% 
      vs. 21.2%; P = 0.02). The severe AE rate was also higher in the EC group than in 
      the LC group (18.3% vs 3.1%; P = 0.001). CONCLUSION: Considering the risk-benefit 
      balance, delayed addition of thiopurine after LOR to IFX might be an alternative 
      strategy when using IFX to treat CD.
CI  - (c) 2020. Springer Science+Business Media, LLC, part of Springer Nature.
FAU - Zeze, Keizo
AU  - Zeze K
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Hirano, Atsushi
AU  - Hirano A
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Torisu, Takehiro
AU  - Torisu T
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 
      torisut@intmed2.med.kyushu-u.ac.jp.
FAU - Esaki, Motohiro
AU  - Esaki M
AD  - Division of Gastroenterology, Department of Internal Medicine, Faculty of 
      Medicine, Saga University, Saga, Japan.
FAU - Moriyama, Tomohiko
AU  - Moriyama T
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Umeno, Junji
AU  - Umeno J
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Kawasaki, Keisuke
AU  - Kawasaki K
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Fujioka, Shin
AU  - Fujioka S
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Fuyuno, Yuta
AU  - Fuyuno Y
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Matsuno, Yuichi
AU  - Matsuno Y
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
FAU - Kitazono, Takanari
AU  - Kitazono T
AD  - Department of Medicine and Clinical Science, Graduate School of Medical Sciences, 
      Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200913
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Antimetabolites)
RN  - 0 (Biological Products)
RN  - B72HH48FLU (Infliximab)
RN  - E7WED276I5 (Mercaptopurine)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
CIN - Dig Dis Sci. 2021 Sep;66(9):2851-2852. PMID: 33128112
MH  - Adult
MH  - Antimetabolites/administration & dosage/adverse effects
MH  - *Azathioprine/administration & dosage/adverse effects
MH  - Biological Products/administration & dosage/adverse effects
MH  - *Crohn Disease/diagnosis/drug therapy/epidemiology
MH  - Drug Monitoring/methods
MH  - Drug Synergism
MH  - *Drug Therapy, Combination/adverse effects/methods
MH  - *Drug-Related Side Effects and Adverse Reactions/diagnosis/etiology
MH  - Female
MH  - Humans
MH  - *Infliximab/administration & dosage/adverse effects
MH  - Japan/epidemiology
MH  - Male
MH  - *Mercaptopurine/administration & dosage/adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Combination therapy
OT  - Crohn's disease
OT  - Infliximab
OT  - Thiopurine
EDAT- 2020/09/14 06:00
MHDA- 2021/09/30 06:00
CRDT- 2020/09/13 20:41
PHST- 2020/05/29 00:00 [received]
PHST- 2020/09/01 00:00 [accepted]
PHST- 2020/09/14 06:00 [pubmed]
PHST- 2021/09/30 06:00 [medline]
PHST- 2020/09/13 20:41 [entrez]
AID - 10.1007/s10620-020-06600-z [pii]
AID - 10.1007/s10620-020-06600-z [doi]
PST - ppublish
SO  - Dig Dis Sci. 2021 Sep;66(9):3124-3131. doi: 10.1007/s10620-020-06600-z. Epub 2020 
      Sep 13.