Effectiveness of Early Thiopurine Use in Korean Patients With Moderate-to-Severe Ulcerative Colitis: A Prospective Multicenter Cohort (MOSAIK) Study.

IF 2.8 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Hye Kyung Hyun, Ji Won Kim, Jun Lee, Yoon Tae Jeen, Tae-Oh Kim, Joo Sung Kim, Jae Jun Park, SungNoh Hong, Dong Il Park, Hyun-Soo Kim, YooJin Lee, Eun Suk Jung, Youngdoe Kim, Su Young Jung, Jae Hee Cheon
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引用次数: 0

Abstract

Background: Thiopurines play an important role in the management of steroid-refractory and steroid-dependent ulcerative colitis. However, the effectiveness of the early use of thiopurines in ulcerative colitis remains controversial.

Materials and methods: In this multicenter prospective cohort (MOSAIK) study, we divided patients with ulcerative colitis into those who underwent early (within 6 mo of diagnosis) and late (6 mo after diagnosis) thiopurine therapy to determine the effectiveness of early thiopurine treatment. The primary outcome was the cumulative rate of clinical relapse (Mayo score >2 points). Multivariate Cox proportional hazards regression was used to identify independent clinical factors associated with the outcomes.

Results: Overall, 333 patients with moderate-to-severe ulcerative colitis were included. Of the 118 patients treated with thiopurines, 65 (55.1%) and 53 (44.9%) received thiopurine therapy within and after 6 months of diagnosis. The cumulative use rate of thiopurines was 38.9% at 3 years after diagnosis. The median initial dose of thiopurines was 0.7 mg/kg (0.3 to 2.0); the median maintenance dose was 1.1 mg/kg (0.3 to 2.4). The cumulative rate of clinical relapse was not significantly different between patients who started thiopurine therapy within 6 months of diagnosis and those who started therapy 6 months after diagnosis (P=0.712). The presence of extraintestinal manifestations (hazard ratio: 4.674, 95% CI: 1.210-18.061, P=0.025) independently predicted an increased risk of clinical relapse.

Conclusions: Patients with ulcerative colitis who received early thiopurine therapy did not differ significantly in terms of clinical relapse compared with those who received late therapy.

韩国中重度溃疡性结肠炎患者早期使用硫嘌呤的疗效:一项前瞻性多中心队列(MOSAIK)研究。
背景:硫嘌呤类药物在治疗类固醇难治性和类固醇依赖性溃疡性结肠炎中发挥着重要作用。然而,早期使用硫嘌呤类药物治疗溃疡性结肠炎的有效性仍存在争议:在这项多中心前瞻性队列研究(MOSAIK)中,我们将溃疡性结肠炎患者分为早期(确诊后 6 个月内)和晚期(确诊后 6 个月内)硫嘌呤治疗患者,以确定早期硫嘌呤治疗的有效性。主要结果是临床复发(梅奥评分大于 2 分)的累积率。多变量考克斯比例危险回归用于确定与结果相关的独立临床因素:共纳入了 333 名中度至重度溃疡性结肠炎患者。在接受硫嘌呤治疗的 118 名患者中,分别有 65 人(55.1%)和 53 人(44.9%)在确诊后 6 个月内和 6 个月后接受了硫嘌呤治疗。确诊 3 年后,硫嘌呤类药物的累计使用率为 38.9%。硫嘌呤初始剂量的中位数为 0.7 毫克/千克(0.3 至 2.0);维持剂量的中位数为 1.1 毫克/千克(0.3 至 2.4)。在确诊后 6 个月内开始接受硫嘌呤治疗的患者与确诊后 6 个月开始接受治疗的患者之间的临床复发累积率无明显差异(P=0.712)。出现肠外表现(危险比:4.674,95% CI:1.210-18.061,P=0.025)可独立预测临床复发风险的增加:结论:早期接受硫嘌呤治疗的溃疡性结肠炎患者与晚期接受治疗的患者在临床复发方面没有显著差异。
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来源期刊
Journal of clinical gastroenterology
Journal of clinical gastroenterology 医学-胃肠肝病学
CiteScore
5.60
自引率
3.40%
发文量
339
审稿时长
3-8 weeks
期刊介绍: Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.
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