Statement of disclosure: The authors have no funding or personal interests to declare.
Addition of thiopurines can recapture response in patients with Crohn's disease who have lost response to anti-tumor necrosis factor monotherapy
Version of Record online: 23 SEP 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 10, pages 1595–1599, October 2013
How to Cite
Ong, D. E. H., Kamm, M. A., Hartono, J. L. and Lust, M. (2013), Addition of thiopurines can recapture response in patients with Crohn's disease who have lost response to anti-tumor necrosis factor monotherapy. Journal of Gastroenterology and Hepatology, 28: 1595–1599. doi: 10.1111/jgh.12263
- Issue online: 23 SEP 2013
- Version of Record online: 23 SEP 2013
- Accepted manuscript online: 10 MAY 2013 10:28AM EST
- Manuscript Accepted: 28 APR 2013
- Crohn's disease;
- inflammatory bowel disease;
- loss of response;
Background and Aim
Anti-tumor necrosis factor (TNF) antibodies are effective in maintaining remission in Crohn's disease. However, a significant proportion of patients lose response to these agents with time. This study aimed to determine whether the introduction of a thiopurine in patients who have lost response to anti-TNF monotherapy results in regained response.
Five patients (four males; aged 22–38 years) with active Crohn's disease, who had an initial response to anti-TNF therapy but had lost response, were commenced on azathioprine or mercaptopurine at standard doses while continuing anti-TNF therapy. All had previously failed thiopurine therapy prior to starting anti-TNF treatment.
All patients experienced improved clinical symptoms within 2–6 months, with benefit sustained over a mean follow-up of 19 months. Two patients with an elevated C-reactive protein at the time of thiopurine addition demonstrated a fall in C-reactive protein. Colonoscopy before and after thiopurine addition in four patients showed improvement in all, with mucosal healing achieved in two. No adverse effects of treatment were noted.
Addition of a thiopurine in patients who have lost response to anti-TNF monotherapy is an effective strategy to recapture response even if the patient has previously failed thiopurine therapy. Thiopurines may reduce immunogenicity or act synergistically with anti-TNF therapy.