Evidence map›Paper›PMID 33755823›Full record

ArticleDigestive diseases and sciences2022

Thiopurine Monotherapy Is Effective in Maintenance of Mild-Moderate Inflammatory Bowel Disease.

Grant E Barber, Steven Hendler, Monica Choe, Kian Keyashian, Sarah Lechner, Berkeley N Limketkai, David Limsui

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Article in Digestive diseases and sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.4field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Grant E BarberDivision of Gastroenterology and Hepatology, ATTN: Internal Medicine Department, Stanford University School of Medicine, 300 Pasteur Dr., Palo Alto, Stanford, CA, 94305, USA. gbarber@stanford.edu.ORCID 0000-0001-8859-8622
Steven HendlerDivision of Gastroenterology, Loyola University Medical Center, Maywood, IL, USA.
Monica ChoeDivision of Gastroenterology and Hepatology, ATTN: Internal Medicine Department, Stanford University School of Medicine, 300 Pasteur Dr., Palo Alto, Stanford, CA, 94305, USA.
Kian KeyashianDivision of Gastroenterology and Hepatology, ATTN: Internal Medicine Department, Stanford University School of Medicine, 300 Pasteur Dr., Palo Alto, Stanford, CA, 94305, USA.
Sarah LechnerDivision of Gastroenterology and Hepatology, ATTN: Internal Medicine Department, Stanford University School of Medicine, 300 Pasteur Dr., Palo Alto, Stanford, CA, 94305, USA.
Berkeley N LimketkaiDivision of Gastroenterology and Digestive Diseases, Los Angeles, CA, USA.
David LimsuiDivision of Gastroenterology and Hepatology, ATTN: Internal Medicine Department, Stanford University School of Medicine, 300 Pasteur Dr., Palo Alto, Stanford, CA, 94305, USA.
Stanford University · USLoyola University Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCrohn's disease (CD) and ulcerative colitis (UC) are complex, inflammatory bowel diseases (IBD) with debilitating complications. While severe IBD typically requires biologic agents, the optimal therapy for mild-moderate IBD is less clear.

aimsTo assess the efficacy of thiopurine monotherapy for maintenance of mild-moderate IBD and clinical variables associated with treatment outcome.

methodsThis retrospective study included adults with mild-moderate IBD who were started on thiopurines without biologic therapy. The primary outcome was therapy failure, defined by disease progression based on clinical, endoscopic, and radiologic criteria. Clinical variables were extracted at time of thiopurine initiation. Univariable and multivariable Cox proportional hazards models were used to examine the independent contribution of the clinical variables on treatment response.

resultsFrom 230 CD patients, 64 (72%) were free of treatment failure with mean follow-up of 3.3 years. In our multivariable model, thiopurine failure was associated with concomitant systemic steroid administration (aHR 2.43, p = 0.001), whereas protective factors included concomitant oral 5-aminosalicylic acid (5-ASA) therapy (aHR 0.54, p = 0.02) and non-fistulizing, non-stricturing disease (aHR 0.57, p = 0.047). From 173 UC patients, 50 (71%) were free from treatment failure with mean follow-up of 3.3 years. On multivariable analysis, concomitant oral steroids were associated with thiopurine failure (aHR 2.71, p = 0.001). Only 13 (4%) discontinued thiopurines from adverse effects.

conclusionsIn mild-moderate uncomplicated IBD, thiopurine monotherapy was associated with longitudinal maintenance of remission and may represent a lower-cost, convenient, and effective alternative to biologics. Multiple clinical variables were predictive of treatment response.

Indexed as

Colitis, UlcerativeCrohn DiseaseInflammatory Bowel DiseasesAdultHumansMesalamineRetrospective StudiesMesalamineCrohn’s diseaseInflammatory bowel diseaseThiopurinesUlcerative colitis

Identifiers

PMID33755823
OpenAlexW3136248921

What OpenQuestion holds

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Read underepoch 390

Registered trials

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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.