152 153 Intestinal Disease Meeting Berlin 2006 - Dr. Falk Pharma ...

Session 3
36
M. Lémann (Paris). M. Lémann also reported current
discussion of a combination of azathioprine
and anti-TNF antibodies (figure 25).
The recurrence rate increases after
azathioprine is discontinued
At this point it must be asked, how long patients
need to be kept on immunosuppressants. In general,
once maintenance of remission with azathioprine
has been started, it should be continued
long-term. Current data show that the recurrence
rate rapidly increases once the immunosuppressant
is discontinued (figure 26). For example,
a study in 157 patients with Crohn’s disease
in whom azathioprine was discontinued
after they had been treated for six months with
the agent, showed a massive increase in disease
recurrence compared to those who continued
to take the medication. In general, a four-year
follow-up shows an increased risk of disease
recurrence is observed after discontinuing the
immunosuppressant.
Fig. 25
Chronically active IBD Emerging indications
Early
I Azathioprine/6-mercaptopurine – when to start? (M. Lémann, Paris)
This was recently confirmed by data reported
from the GETAID (Groupe d'Etudes Therapeutiques
des Affections Inflammatoires Digestives)
study, which found an increase in disease recurrence
after discontinuing azathioprine. In the
study, 83% of patients receiving azathioprine
reported no acute symptoms. Patients in whom
a placebo was substituted for azathioprine,
however, suffered a disease relapse within
18 months in 21% of cases, compared to only
8% of those who continued to receive azathioprine.
According to M. Lémann, the risk of recurrence
is significantly increased in patients taking
azathioprine for periods less than 3.5–4 years.
“Azathioprine should be taken for at least this
period of time,” M. Lémann advised.
In addition, the risk of recurrence can be assessed
using biological markers, such as the CRP level.
“High CRP levels combined with low hemoglobin
suggests an increased risk of recurrence,”
M. Lémann said.
Postoperative prevention
Combined with anti-TNF antibodies