ArticleAlimentary pharmacology & therapeutics2014
Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease: relapse and recapture rates, with predictive factors in 237 patients.
Article in Alimentary pharmacology & therapeutics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.
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- The decline of 6-thioguanine nucleotides is not linked to impaired efficacy or safety of thiopurines in pregnant women with inflammatory bowel disease.British journal of clinical pharmacology · 2026Article
- Relapse Rates and Predictors Following Azathioprine Withdrawal in Inflammatory Bowel Disease: A Systematic Review, Meta-Analysis, and Meta-Regression.Journal of clinical medicine · 2025Review
- IBD 2024: Charting a New Course in IBD Proceedings of the Takeda Symposium 22-23 November 2024 W Hotel, Brisbane, Queensland, Australia.Journal of gastroenterology and hepatology · 2025Article
- Defining Comprehensive Disease Control for Use as a Treatment Target for Ulcerative Colitis in Clinical Practice: International Delphi Consensus Recommendations.Journal of Crohn's & colitis · 2024Review
- 18F-FDG-PET and other imaging modalities in the diagnosis and management of inflammatory bowel disease.American journal of nuclear medicine and molecular imaging · 2024Review
- Azathioprine monotherapy withdrawal in inflammatory bowel diseases: A retrospective mono-centric study.World journal of gastroenterology · 2023Article
- Exit strategies in inflammatory bowel disease: Looking beyond anti-tumor necrosis factors.World journal of clinical cases · 2023Review
- Treatment escalation and de-escalation decisions in Crohn's disease: Delphi consensus recommendations from Japan, 2021.Journal of gastroenterology · 2023Review
- De-escalation of Therapy in Patients with Quiescent Inflammatory Bowel Disease.Gut and liver · 2023Review
- Evidence-Based Approach to the Discontinuation of Immunomodulators or Biologics in Inflammatory Bowel Disease.Digestion · 2023Review
- Relapse rates after withdrawal of thiopurines in patients with inflammatory bowel disease.International journal of colorectal disease · 2022Article
- Cutaneous Kaposi's sarcoma in an HIV-negative patient with Crohn's disease on thiopurine immunosuppression.BMJ case reports · 2021Article
- Evolving Role of Thiopurines in Inflammatory Bowel Disease in the Era of Biologics and New Small Molecules.Digestive diseases and sciences · 2021Review
- Comparison of inflammatory bowel disease relapse after top-down or step-up therapy: a population-based cohort study.International journal of colorectal disease · 2021Article
- Article
- IBD in the Elderly: Management Challenges and Therapeutic Considerations.Current gastroenterology reports · 2019Review
- Withdrawal of Azathioprine in Inflammatory Bowel Disease Patients Who Sustain Remission: New Risk Factors for Relapse.Digestive diseases and sciences · 2019Observational
- Treatment De-Escalation in Patients With Inflammatory Bowel Disease.Gastroenterology & hepatology · 2019Article
- De-escalation of Therapy in Inflammatory Bowel Disease.Current gastroenterology reports · 2018Review
Corrections and comments
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Authors and funding
26 authors at 11 institutions in 1 country.
Funding
Abstract
backgroundThiopurines (azathioprine and mercaptopurine) remain integral to most medical strategies for maintaining remission in Crohn's disease (CD) and ulcerative colitis (UC). Indefinite use of these drugs is tempered by long-term risks. While clinical relapse is noted frequently following drug withdrawal, there are few published data on predictive factors.
aimTo investigate the success of planned thiopurine withdrawal in patients in sustained clinical remission to identify rates and predictors of relapse.
methodsThis was a multicentre retrospective cohort study from 11 centres across the UK. Patients included had a definitive diagnosis of IBD, continuous thiopurine use ≥3 years and withdrawal when in sustained clinical remission. All patients had a minimum of 12 months follow-up post drug withdrawal. Primary and secondary end points were relapse at 12 and 24 months respectively.
results237 patients were included in the study (129 CD; 108 UC). Median duration of thiopurine use prior to withdrawal was 6.0 years (interquartile range 4.4-8.4). At follow-up, moderate/severe relapse was observed in 23% CD and 12% UC patients at 12 months, 39% CD and 26% UC at 24 months. Relapse rate at 12 months was significantly higher in CD than UC (P = 0.035). Elevated CRP at withdrawal was associated with higher relapse rates at 12 months for CD (P = 0.005), while an elevated white cell count was predictive at 12 months for UC (P = 0.007).
conclusionThiopurine withdrawal in the context of sustained remission is associated with a 1-year moderate-to-severe relapse rate of 23% in Crohn's disease and 12% in ulcerative colitis.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.