Leukopenia Predicts Remission in Patients with Inflammatory Bowel Disease and Behcet’s Disease on Thiopurine Maintenance

Mi Sung Park, Dong Hyun Kim, Duk Hwan Kim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, JaeHee Cheon

Research output: Contribution to journalArticle

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Abstract

Methods: We included 196 IBD patients [45 with ulcerative colitis (UC), 68 with Crohn’s disease (CD), and 83 with intestinal Behçet’s disease (BD)] who were treated with AZA/6-MP and achieved remission between January 2006 and December 2012. We retrospectively analyzed patient characteristics, AZA/6-MP maintenance dose (mg/kg), the lowest white blood cell (WBC) count during AZA/6-MP treatment, duration of remission, and the occurrence of relapse. We compared the clinical variables between leukopenic (n = 120, WBC count <4,000/μL) and nonleukopenic (n = 76, WBC count ≥4,000/μL) patients.

Results: The two groups were well matched for baseline clinical characteristics. The cumulative relapse-free survival rate was higher in the leukopenic group than the nonleukopenic group by Kaplan–Meier survival analysis (log-rank test, P < 0.001). On multivariate analysis, age, duration of AZA/6-MP treatment, presence of macrocytosis, and the presence of leukopenia were negatively associated with relapse (odds ratios 0.975, 0.988, 0.563, and 0.390, respectively). On subgroup analysis, the cumulative relapse-free survival rate was significantly higher in the leukopenic group than in the nonleukopenic group for all types of IBDs, including UC, CD, and intestinal BD (log-rank test, P = 0.032, 0.047, and 0.002, respectively).

Conclusion: Leukopenia during thiopurine maintenance therapy was associated with prolonged remission in patients with IBD and Behcet’s disease.

Backgrounds: The thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine (6-MP) are well-established drugs for the treatment of inflammatory bowel disease (IBD). Although leukopenia is a well-recognized side effect of AZA/6-MP treatment, its association with therapeutic effects has yet to be determined. We therefore evaluated the influences of thiopurine-induced leukopenia on the long-term prognosis of IBD.

Original languageEnglish
Pages (from-to)195-204
Number of pages10
JournalDigestive diseases and sciences
Volume60
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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6-Mercaptopurine
Behcet Syndrome
Azathioprine
Leukopenia
Inflammatory Bowel Diseases
Maintenance
Leukocyte Count
Recurrence
Intestinal Diseases
Ulcerative Colitis
Crohn Disease
Survival Rate
Therapeutics
Therapeutic Uses
Survival Analysis
Pharmaceutical Preparations
Multivariate Analysis
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

Park, Mi Sung ; Kim, Dong Hyun ; Kim, Duk Hwan ; Park, Soo Jung ; Hong, Sung Pil ; Kim, Tae Il ; Kim, Won Ho ; Cheon, JaeHee. / Leukopenia Predicts Remission in Patients with Inflammatory Bowel Disease and Behcet’s Disease on Thiopurine Maintenance. In: Digestive diseases and sciences. 2014 ; Vol. 60, No. 1. pp. 195-204.
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title = "Leukopenia Predicts Remission in Patients with Inflammatory Bowel Disease and Behcet’s Disease on Thiopurine Maintenance",
abstract = "Methods: We included 196 IBD patients [45 with ulcerative colitis (UC), 68 with Crohn’s disease (CD), and 83 with intestinal Beh{\cc}et’s disease (BD)] who were treated with AZA/6-MP and achieved remission between January 2006 and December 2012. We retrospectively analyzed patient characteristics, AZA/6-MP maintenance dose (mg/kg), the lowest white blood cell (WBC) count during AZA/6-MP treatment, duration of remission, and the occurrence of relapse. We compared the clinical variables between leukopenic (n = 120, WBC count <4,000/μL) and nonleukopenic (n = 76, WBC count ≥4,000/μL) patients.Results: The two groups were well matched for baseline clinical characteristics. The cumulative relapse-free survival rate was higher in the leukopenic group than the nonleukopenic group by Kaplan–Meier survival analysis (log-rank test, P < 0.001). On multivariate analysis, age, duration of AZA/6-MP treatment, presence of macrocytosis, and the presence of leukopenia were negatively associated with relapse (odds ratios 0.975, 0.988, 0.563, and 0.390, respectively). On subgroup analysis, the cumulative relapse-free survival rate was significantly higher in the leukopenic group than in the nonleukopenic group for all types of IBDs, including UC, CD, and intestinal BD (log-rank test, P = 0.032, 0.047, and 0.002, respectively).Conclusion: Leukopenia during thiopurine maintenance therapy was associated with prolonged remission in patients with IBD and Behcet’s disease.Backgrounds: The thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine (6-MP) are well-established drugs for the treatment of inflammatory bowel disease (IBD). Although leukopenia is a well-recognized side effect of AZA/6-MP treatment, its association with therapeutic effects has yet to be determined. We therefore evaluated the influences of thiopurine-induced leukopenia on the long-term prognosis of IBD.",
author = "Park, {Mi Sung} and Kim, {Dong Hyun} and Kim, {Duk Hwan} and Park, {Soo Jung} and Hong, {Sung Pil} and Kim, {Tae Il} and Kim, {Won Ho} and JaeHee Cheon",
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Leukopenia Predicts Remission in Patients with Inflammatory Bowel Disease and Behcet’s Disease on Thiopurine Maintenance. / Park, Mi Sung; Kim, Dong Hyun; Kim, Duk Hwan; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, JaeHee.

In: Digestive diseases and sciences, Vol. 60, No. 1, 01.01.2014, p. 195-204.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Leukopenia Predicts Remission in Patients with Inflammatory Bowel Disease and Behcet’s Disease on Thiopurine Maintenance

AU - Park, Mi Sung

AU - Kim, Dong Hyun

AU - Kim, Duk Hwan

AU - Park, Soo Jung

AU - Hong, Sung Pil

AU - Kim, Tae Il

AU - Kim, Won Ho

AU - Cheon, JaeHee

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Methods: We included 196 IBD patients [45 with ulcerative colitis (UC), 68 with Crohn’s disease (CD), and 83 with intestinal Behçet’s disease (BD)] who were treated with AZA/6-MP and achieved remission between January 2006 and December 2012. We retrospectively analyzed patient characteristics, AZA/6-MP maintenance dose (mg/kg), the lowest white blood cell (WBC) count during AZA/6-MP treatment, duration of remission, and the occurrence of relapse. We compared the clinical variables between leukopenic (n = 120, WBC count <4,000/μL) and nonleukopenic (n = 76, WBC count ≥4,000/μL) patients.Results: The two groups were well matched for baseline clinical characteristics. The cumulative relapse-free survival rate was higher in the leukopenic group than the nonleukopenic group by Kaplan–Meier survival analysis (log-rank test, P < 0.001). On multivariate analysis, age, duration of AZA/6-MP treatment, presence of macrocytosis, and the presence of leukopenia were negatively associated with relapse (odds ratios 0.975, 0.988, 0.563, and 0.390, respectively). On subgroup analysis, the cumulative relapse-free survival rate was significantly higher in the leukopenic group than in the nonleukopenic group for all types of IBDs, including UC, CD, and intestinal BD (log-rank test, P = 0.032, 0.047, and 0.002, respectively).Conclusion: Leukopenia during thiopurine maintenance therapy was associated with prolonged remission in patients with IBD and Behcet’s disease.Backgrounds: The thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine (6-MP) are well-established drugs for the treatment of inflammatory bowel disease (IBD). Although leukopenia is a well-recognized side effect of AZA/6-MP treatment, its association with therapeutic effects has yet to be determined. We therefore evaluated the influences of thiopurine-induced leukopenia on the long-term prognosis of IBD.

AB - Methods: We included 196 IBD patients [45 with ulcerative colitis (UC), 68 with Crohn’s disease (CD), and 83 with intestinal Behçet’s disease (BD)] who were treated with AZA/6-MP and achieved remission between January 2006 and December 2012. We retrospectively analyzed patient characteristics, AZA/6-MP maintenance dose (mg/kg), the lowest white blood cell (WBC) count during AZA/6-MP treatment, duration of remission, and the occurrence of relapse. We compared the clinical variables between leukopenic (n = 120, WBC count <4,000/μL) and nonleukopenic (n = 76, WBC count ≥4,000/μL) patients.Results: The two groups were well matched for baseline clinical characteristics. The cumulative relapse-free survival rate was higher in the leukopenic group than the nonleukopenic group by Kaplan–Meier survival analysis (log-rank test, P < 0.001). On multivariate analysis, age, duration of AZA/6-MP treatment, presence of macrocytosis, and the presence of leukopenia were negatively associated with relapse (odds ratios 0.975, 0.988, 0.563, and 0.390, respectively). On subgroup analysis, the cumulative relapse-free survival rate was significantly higher in the leukopenic group than in the nonleukopenic group for all types of IBDs, including UC, CD, and intestinal BD (log-rank test, P = 0.032, 0.047, and 0.002, respectively).Conclusion: Leukopenia during thiopurine maintenance therapy was associated with prolonged remission in patients with IBD and Behcet’s disease.Backgrounds: The thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine (6-MP) are well-established drugs for the treatment of inflammatory bowel disease (IBD). Although leukopenia is a well-recognized side effect of AZA/6-MP treatment, its association with therapeutic effects has yet to be determined. We therefore evaluated the influences of thiopurine-induced leukopenia on the long-term prognosis of IBD.

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