P309 Withdrawal of thiopurines in Inflammatory Bowel Disease patients in stable remission: a prospective, multicentre cohort study
Bibliographic record
Abstract
Abstract Background Thiopurines including azathioprine [AZA], mercaptopurine [MP] and tioguanine [TG] are cornerstone therapies in the maintenance treatment of inflammatory bowel diseases (IBD). Withdrawal in patients in stable remission may reduce the risk of infections and malignancies, but little is known about the subsequent risk of relapse. This study aimed to assess the relapse rate after discontinuation of thiopurines in IBD patients in stable remission. Methods Patients with IBD discontinuing thiopurine therapy were prospectively included in, 14 Dutch hospitals if they used a thiopurine for at least one year, and were in steroid-free clinical remission for one year or longer. Clinical, biochemical, endoscopic and radiological data were collected at baseline (thiopurine cessation), and at, 3, 6, 12 and, 24 months thereafter. The primary endpoint was disease relapse, defined as: induction or escalation of therapy, or, if available, endoscopic activity, indicated by simple endoscopic score (SES-CD) >, 4 for Crohn’s disease (CD) or endoscopic Mayo >, 1 for ulcerative colitis and IBD unclassified (UC/IBDU). Cox regression analysis was used to determine predictors of relapse. Results We enrolled, 134 patients (94 CD [70%]; AZA, 56%, MP, 20%, TG, 25%) with a median age of, 44.0 years (IQR, 30.8–59.0). Fifty-three (40%) patients received concomitant anti-tumour necrosis factor alpha (anti-TNF) at baseline. The median therapy duration before cessation was, 61.5 months (IQR, 40.0–111.0), median time of clinical remission before cessation was, 43.5 months (IQR, 27.8–65.5). During the median follow-up time of, 14.0 (IQR, 11.9–19.7) months after cessation, 37 (28%) patients relapsed (Figure, 1). Relapse rates at, 12 and, 24 months were, 28% and, 40%, respectively. Median time to relapse was, 10.9 (IQR, 5.5–16.5) months. UC/IBDU patients had a higher risk of relapse (HR, 2.603 [95% CI, 1.364 -4.965], p=0.004). Relapse free survival probability in patients with and without concomitant anti-TNF was not significantly different (anti-TNF, 82%, no anti-TNF, 87%, log rank=0.494, Figure, 2). Type of thiopurine, concomitant, 5-ASA, remission duration, therapy duration before cessation, baseline mucosal healing, and baseline faecal calprotectin were not predictive of relapse. After relapse, 27 patients received steroids (18 budesonide, 9 prednisone), 15 (re)started thiopurines, 8 initiated anti-TNF, and, 8 intensified concomitant anti-TNF. Figure 1 Figure 2 Conclusion This prospective study showed relapse rates of, 28% and, 40% at, 12 and, 24 months, respectively, after cessation of thiopurines for stable remission. UC/IBDU patients had a higher risk of relapse. Type of thiopurine, remission duration, concomitant, 5-ASA or anti-TNF were not predictive of continuing remission.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".