PWE-090 Outcomes of Patients with Ulcerative Colitis who are Azathioprine Tolerant and Azathioprine Intolerant
Notice bibliographique
Résumé
Introduction Azathioprine therapy is an immunosuppressive drug that is widely used in the management of ulcerative colitis. 20% of patients with normal TPMT are not able to tolerate the drug and 30% do not respond [1]. For patients who are intolerant to azathioprine, other medicines have been proposed and these include methotrexate, mercaptopurine and infliximab. Methods A cross sectional study was performed using the Milton Keynes Hospital IBD database to compare patients were azathioprine intolerant and those that were azathioprine tolerant. A descriptive analysis of clinical features and outcomes of these two groups was performed. Disease activity scores were based on the montreal classification ranging from S0 (clinical remission) to S3 (severe disease). Results 98 patients were recruited of which 32.7% were intolerant to azathioprine. The median age of azathioprine intolerant patients was 47.5 years and 30.3% were male. In the azathioprine tolerant cohort, the median age was 46 years and 53.0% were male. Azathioprine was not tolerated due to deranged liver function tests in 43.3%, gastrointestinal symptoms of nausea/vomiting in 23.3%, cutaneous side effects in 10.0%, migraines in 6.7% and infections in 3.3%. Abstract PWE-090 Table Azathioprine intolerant (n = 32) Azathioprine tolerant (n = 66) Requiring surgery (%) 6 (18.8) 11 (16.6) Extensive disease (%) 9 (28.1) 24 (36.4) S2/S3 disease (%) 11 (34.4) 19 (28.7) S0/S1 disease (%) 21 (65.6) 47 (71.2) S0 disease- remission (%) 12 (37.5) 30 (45.5) Steroid dependent (%) 9 (28.1) 0 (0.0) Conclusion Azathioprine is a drug that is not tolerated in nearly a third of Ulcerative Colitis patients and this effect demonstrated a sex bias towards females. The most likely reason for azathioprine intolerance was deranged liver function tests, however, intolerable gastrointestinal symptoms are noted. The intolerance of azathioprine is not a prognostic marker that patients will be more likely to undergo colectomy or that their ulcerative colitis will become extensive. However, there is evidence that compared to azathioprine tolerant patients, for every 100 who are intolerant, 8 less will be in remission and 6 will have more severe disease. Finally, we note that prolonged use of low-dose steroids in modern practise is utilised rarely and it is feasible that this trend may lead to increased symptoms at a population level. Disclosure of Interest None Declared. References M. Wahed, J. R. Louis-Auguste, L. M. Baxter, J. K. Limdi, S. A. Mccartney, J. O. Lindsay, and S. L. Bloom, “Efficacy of methotrexate in Crohn’s disease and ulcerative colitis patients unresponsive or intolerant to azathioprine/mercaptopurine,” Alimentary Pharmacology & Therapeutic s, vol. 30, no. 6, pp. 614–620, 2009.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».