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Predicting the need for azathioprine at first presentation in children with inflammatory bowel disease.

Abstract

OBJECTIVE

Although azathioprine usually is reserved for inflammatory bowel disease that proves difficult to control, routine early use has recently been advocated for children with Crohn disease. However, this practice carries with it an increased risk of adverse reactions. The objective of this study was to look for characteristics at first presentation that may identify those likely to benefit from early azathioprine.

PATIENTS AND METHODS

Study setting was a tertiary pediatric gastroenterology department. Retrospective cohort study of 156 children (93 Crohn disease, 47 ulcerative colitis, 16 indeterminate colitis), comparing characteristics at presentation in those who did and did not eventually require azathioprine. Azathioprine was reserved for patients with frequent relapses and steroid dependence/resistance. Twenty variables were examined, including patient and disease characteristics and initial treatment response. These were analysed using Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazard regression.

RESULTS

Median follow-up was 3.9 years (range 0.5-10.6 years). Azathioprine was used in 36% with Crohn disease and 40% with ulcerative colitis. Median time to commencing azathioprine was 14 months (range 3-77.5 months). Multifactorial analysis revealed an association with endoscopic colitis severity in Crohn disease (P < 0.02). However, only 50% with severe Crohn colitis actually needed azathioprine. There was an association with need for intravenous corticosteroids for induction of remission in Crohn disease (P < 0.006) and ulcerative colitis (P < 0.05). Of these patients, 75% required azathioprine.

CONCLUSIONS

These findings support the early use of azathioprine in children who require intravenous corticosteroids to induce initial remission. No other characteristics examined were of clinical utility in predicting need for azathioprine.

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  • Authors+Show Affiliations

    ,

    Institute of Child Health, Birmingham, UK.

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    Source

    MeSH

    Azathioprine
    Child
    Child, Preschool
    Cohort Studies
    Colitis, Ulcerative
    Crohn Disease
    Factor Analysis, Statistical
    Female
    Follow-Up Studies
    Humans
    Immunosuppressive Agents
    Inflammatory Bowel Diseases
    Kaplan-Meier Estimate
    Male
    Proportional Hazards Models
    Recurrence
    Remission Induction
    Retrospective Studies
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    18664861

    Citation

    Mossop, Hilary, et al. "Predicting the Need for Azathioprine at First Presentation in Children With Inflammatory Bowel Disease." Journal of Pediatric Gastroenterology and Nutrition, vol. 47, no. 2, 2008, pp. 123-9.
    Mossop H, Davies P, Murphy MS. Predicting the need for azathioprine at first presentation in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2008;47(2):123-9.
    Mossop, H., Davies, P., & Murphy, M. S. (2008). Predicting the need for azathioprine at first presentation in children with inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition, 47(2), pp. 123-9. doi:10.1097/MPG.0b013e318156a834.
    Mossop H, Davies P, Murphy MS. Predicting the Need for Azathioprine at First Presentation in Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2008;47(2):123-9. PubMed PMID: 18664861.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Predicting the need for azathioprine at first presentation in children with inflammatory bowel disease. AU - Mossop,Hilary, AU - Davies,P, AU - Murphy,M S, PY - 2008/7/31/pubmed PY - 2008/11/18/medline PY - 2008/7/31/entrez SP - 123 EP - 9 JF - Journal of pediatric gastroenterology and nutrition JO - J. Pediatr. Gastroenterol. Nutr. VL - 47 IS - 2 N2 - OBJECTIVE: Although azathioprine usually is reserved for inflammatory bowel disease that proves difficult to control, routine early use has recently been advocated for children with Crohn disease. However, this practice carries with it an increased risk of adverse reactions. The objective of this study was to look for characteristics at first presentation that may identify those likely to benefit from early azathioprine. PATIENTS AND METHODS: Study setting was a tertiary pediatric gastroenterology department. Retrospective cohort study of 156 children (93 Crohn disease, 47 ulcerative colitis, 16 indeterminate colitis), comparing characteristics at presentation in those who did and did not eventually require azathioprine. Azathioprine was reserved for patients with frequent relapses and steroid dependence/resistance. Twenty variables were examined, including patient and disease characteristics and initial treatment response. These were analysed using Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazard regression. RESULTS: Median follow-up was 3.9 years (range 0.5-10.6 years). Azathioprine was used in 36% with Crohn disease and 40% with ulcerative colitis. Median time to commencing azathioprine was 14 months (range 3-77.5 months). Multifactorial analysis revealed an association with endoscopic colitis severity in Crohn disease (P < 0.02). However, only 50% with severe Crohn colitis actually needed azathioprine. There was an association with need for intravenous corticosteroids for induction of remission in Crohn disease (P < 0.006) and ulcerative colitis (P < 0.05). Of these patients, 75% required azathioprine. CONCLUSIONS: These findings support the early use of azathioprine in children who require intravenous corticosteroids to induce initial remission. No other characteristics examined were of clinical utility in predicting need for azathioprine. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/18664861/Predicting_the_need_for_azathioprine_at_first_presentation_in_children_with_inflammatory_bowel_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=18664861 DB - PRIME DP - Unbound Medicine ER -