ArticleGut2021
Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn's disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource.
Article in Gut, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 4 of them syntheses that pooled it.
What it found
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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.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 4 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Biologic therapy for Crohn's disease (2015-2025): a bibliometric analysis of global research trends and current status.Frontiers in pharmacology · 2026Pooled it
- Second United Arab Emirates consensus guidance on the diagnosis and management of inflammatory bowel disease.World journal of gastroenterology · 2025Pooled it
- Partial Enteral Nutrition in the Management of Crohn's Disease: A Systematic Review and Meta-Analysis.Journal of Crohn's & colitis · 2025Pooled it
- AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis.Gastroenterology · 2024Guideline
- Mercaptopurine for the Treatment of Ulcerative Colitis: A Randomized Placebo-Controlled Trial.Journal of Crohn's & colitis · 2023Trial
- Methotrexate toxicity and intolerance in paediatric inflammatory bowel disease: A retrospective cohort study.Journal of pediatric gastroenterology and nutrition · 2026Article
- Adverse Events Related to Azathioprine Use in Patients With Inflammatory Bowel Disease: A Real-World Cohort Study.Gastroenterology research and practice · 2026Article
- Endometrial stromal sarcoma in a patient with ulcerative colitis receiving immunosuppressive therapy: A case report and review of literature.World journal of clinical cases · 2025Article
- A large-scale comparison of clinical outcomes to IBD therapies in White and South Asian ethnicities.EClinicalMedicine · 2025Article
- Cerium single-atom catalysts-armedActa pharmaceutica Sinica. B · 2025Article
- Examination of the TPMT and NUDT15*3 Variants to Predict the Response to Thiopurines in an Italian Cohort of Patients with Inflammatory Bowel Disease.International journal of molecular sciences · 2025Article
- Anti-Inflammatory Effects of Algae-Derived Biomolecules in Gut Health: A Review.International journal of molecular sciences · 2025Review
- Tryptophan metabolites profile predict remission with dietary therapy in pediatric Crohn's disease.Therapeutic advances in gastroenterology · 2025Article
- The Effectiveness and Safety of First-Line Thioguanine in Thiopurine-Naïve Inflammatory Bowel Disease Patients.Inflammatory bowel diseases · 2024Article
- Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study.BMJ open gastroenterology · 2024Article
- Choosing Therapies in Ulcerative Colitis.Journal of the Canadian Association of Gastroenterology · 2024Article
- Differences in the risk of clinical failure between thiopurine and methotrexate in bio-naïve patients with Crohn's disease: a Korean nationwide population-based study.Therapeutic advances in gastroenterology · 2024Article
- Thiopurine Exposure During Pregnancy is Not Associated With Anemia in Infants Born to Mothers With IBD.Crohn's & colitis 360 · 2023Article
- Long-term safety and effectiveness of azathioprine in the management of inflammatory bowel disease: A real-world experience.JGH open : an open access journal of gastroenterology and hepatology · 2023Article
- Unraveling the Impact of Gut and Oral Microbiome on Gut Health in Inflammatory Bowel Diseases.Nutrients · 2023Review
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveThiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn's disease (CD), including their impact on need for surgery.
designOutcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines.
resultsUsing 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015).
conclusionThiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD.
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Registered trials
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.