The Crohn’s Disease-Ulcerative Colitis Clinical AppraisalPart II

Academic Content

Publication Overview Introduction Navigating this Publication See Part I

Step 1 -

Rationale and Definition

Step 2 -

International Clinician Survey Results

Step 3 -

Data Review and Faculty Summary

Step 4 -

International and Faculty Survey Comparison and Faculty Discussion

Step 5 -

Dr. Panés’ Observed Future Directions and References

Faculty Presentations

Statement 1 Statement 2 Statements
3a and 3b Statement 4 Statement 5 Statement 6 Statement 7 Statement 8

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Clinical Gastroentrology and Hepatology

Dr. Panés’ Observed Future Directions

The available therapeutic options for IBD treatment are associated with several limitations, and optimized use of each is necessary to improve long-term disease outcomes. Further studies are needed to assess the effectiveness of thiopurines in well-defined therapeutic strategies and development of predictors of both treatment response and patient susceptibility to adverse events.

References

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Bean RH. Treatment of ulcerative colitis with antimetabolites. Br Med J 1966;1(5495):1081-1084.

[2]

Brooke BN, Hoffmann DC, Swarbrick ET. Azathioprine for Crohn's disease. Lancet 1969;2(7621):612-614.

[3]

Talley NJ, Abreu MT, Achkar JP, et al. An evidence-based systematic review on medical therapies for inflammatory bowel disease. Am J Gastroenterol 2011;106(Suppl 1):S2-S25.

[4]

Panes J, Lopez-Sanroman A, Bermejo F, et al; AZTEC Study Group. Early azathioprine therapy Is no more effective than placebo for newly diagnosed Crohn's disease. Gastroenterology 2013;145:766-774..

[5]

Cosnes J, Bourrier A, Laharie D, et al; Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID). Early administration of azathioprine vs conventional management of Crohn's disease: A randomized controlled trial. Gastroenterology 2013;145:758-765.

[6]

Chande N, Tsoulis DJ, MacDonald JK. Azathioprine or 6-mercaptopurine for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2013;4:CD000545.

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Khan KJ, Dubinsky MC, Ford AC, et al. Efficacy of immunosuppressive therapy for inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011;106:630-642..

[8]

Markowitz J, Grancher K, Kohn N, et al. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology 2000;119:895-902.

[9]

Boyle BM, Kappelman MD, Colletti RB, et al. Routine use of thiopurines in maintaining remission in pediatric Crohn's disease. World J Gastroenterol. 2014;20:9185-9190.

[10]

Pearson DC, May GR, Fick GH, et al. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med. 1995;123:132-142.

[11]

Dejaco C, Harrer M, Waldhoer T, et al. Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease. Aliment Pharmacol Ther. 2003;18:1113-1120.

[12]

Chatu S, Saxena S, Subramanian V, et al. The impact of timing and duration of thiopurine treatment on first intestinal resection in Crohn's disease: National UK population-based study 1989-2010. Am J Gastroenterol. 2014;109:409-16.

[13]

Rungoe C, Langholz E, Andersson M, et al. Changes in medical treatment and surgery rates in inflammatory bowel disease: a nationwide cohort study 1979-2011. Gut 2014;63:1607-1616.

[14]

Peyrin-Biroulet L, Oussalah A, Williet N, et al. Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease. Gut 2011;60:930-936.

[15]

Chatu S, Subramanian V, Saxena S, et al. The role of thiopurines in reducing the need for surgical resection in Crohn's disease: A systematic review and meta-analysis. Am J Gastroenterol. 2014;109:23-34.

[16]

Peyrin-Biroulet L, Deltenre P, Ardizzone S, et al. Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn's disease: a meta-analysis. Am J Gastroenterol. 2009;104:2089-2096.

[17]

Siegel CA, Sands BE. Review article: Practical management of inflammatory bowel disease patients taking immunomodulators. Aliment Pharmacol Ther. 2005;22:1-16.

[18]

de Boer NK, Derijks LJ, Gilissen LP, et al. On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients. World J Gastroenterol. 2005;11:5540-5544.

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