Therapeutic Advances in Gastroenterology (Mar 2024)

Effectiveness and safety of azathioprine for inflammatory pouch disorders: results from the RESERVO study of GETECCU

  • Francisco Mesonero,
  • Yamile Zabana,
  • Agnès Fernández-Clotet,
  • Eduardo Leo-Carnerero,
  • Berta Caballol,
  • Andrea Núñez-Ortiz,
  • María José García,
  • Federico Bertoletti,
  • Alejandro Mínguez,
  • Gerard Suris,
  • Begoña Casis,
  • Rocío Ferreiro-Iglesias,
  • Margalida Calafat,
  • Itxaso Jiménez,
  • José Miranda-Bautista,
  • Luis Javier Lamuela,
  • Ingrid Fajardo,
  • Leyanira Torrealba,
  • Rodrigo Nájera,
  • Rosa María Sáiz-Chumillas,
  • Irene González,
  • Miren Vicuña,
  • Natalia García-Morales,
  • Ana Gutiérrez,
  • Alicia López-García,
  • José Manuel Benítez,
  • Cristina Rubín de Célix,
  • Coral Tejido,
  • Eduard Brunet,
  • Alejandro Hernández-Camba,
  • Cristina Suárez,
  • Iago Rodríguez-Lago,
  • Marta Piqueras,
  • Andrés Castaño,
  • Laura Ramos,
  • Ana Sobrino,
  • María Carmen Rodríguez-Grau,
  • Alfonso Elosua,
  • Miguel Montoro,
  • Ruth Baltar,
  • José María Huguet,
  • Benito Hermida,
  • Antonio Caballero-Mateos,
  • Luis Sánchez-Guillén,
  • Abdel Bouhmidi,
  • Ramón Pajares,
  • Iria Baston-Rey,
  • Antonio López-Sanromán,
  • Agustin Albillos,
  • Manuel Barreiro-de Acosta

DOI
https://doi.org/10.1177/17562848241234476
Journal volume & issue
Vol. 17

Abstract

Read online

Background: The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders. Objective: To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders. Design: This was a retrospective and multicentre study. Methods: We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI). Results: In all, 63 patients were included [54% males; median age, 49 (28–77) years]. The therapy was used to treat pouchitis ( n = 37) or Crohn’s disease of the pouch ( n = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11–55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2–4) to 1 (range 0–3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy. Conclusion: Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option.