Two recent studies published in Gastroenterology have found that early administration of azathioprine in Crohn's disease (CD) patients was no more effective than standard care or placebo for achieving sustained corticosterioid-free remission. Despite these findings, Daisy Batista, M.D., and other gastroenterologists believe there is still a role for azathioprine use in the management of Crohn's disease.
The first study, published in Gastroenterology, compared the effectiveness of early treatment (within 6 months after diagnosis) with azathioprine versus conventional treatment of CD patients who were at high risk for disabling disease. In a multicenter, open-lab trial, patients were randomly assigned to treatment with azathioprine or conventional management. At the end of a 3-year follow up, researchers concluded that there was no difference between the early azathioprine group compared to the conventional management group in the maintenance of remission.
In a second, separate study, also published in Gastroenterology, patients diagnosed with CD within the previous 8 weeks were randomly assigned azathioprine or placebo. After 76 weeks of treatment it was concluded that azathioprine treatment was no more effective than placebo to achieve sustained corticosteroid-free remission. However, subgroup analysis showed that azathioprine therapy was more effective in preventing moderate to severe relapse.
Dr. Batista and other gastroenterologists still believe that azathioprine can be an effective treatment for the management of Crohn's disease in certain cases. She notes that in the SONIC trial, patients who were treated with combination therapy with a thiopurine and infliximab were shown to have better response rates in reduction and maintenance of remission. Also, patients with severe disease seem to benefit from azathioprine treatment.
These studies raise the possibility that perhaps gastroenterologists need to be more aggressive moving forward toward biologic therapy, especially in those patients who don't seem to be responding to thiopurine therapy and for those who are at high risk for complicated disease and disease progression.
Dr. Batista is a gastroenterologist and IBD Fellow at Mayo Clinic specializing in the care and evaluation of patients with IBD.