Is early more effective than late thiopurine use in moderate-to-severe UC?

Early treatment with thiopurine does not significantly differ in terms of clinical relapse when compared with late therapy in patients with moderate-to-severe ulcerative colitis (UC), as shown in a study.

In total, 333 patients with moderate-to-severe UC were enrolled in this study. Of these, 118 received thiopurines; 65 (55.1 percent) were treated within 6 months of diagnosis and 53 (44.0 percent) after 6 months of diagnosis. The cumulative thiopurine use rate was 38.9 percent 3 years after diagnosis.

Participants received a median initial thiopurine dose of 0.7 mg/kg, while the median maintenance dose was 1.1 mg/kg.

No significant difference was noted in the cumulative rate of clinical relapse (Mayo score >2 points) between patients who started thiopurine therapy within 6 months of diagnosis and those who initiated treatment 6 months after diagnosis (p=0.712). Notably, the presence of extraintestinal manifestation (hazard ratio, 4.674, 95 percent confidence interval, 1.210–18.061; p=0.025) was independently associated with an elevated risk of clinical relapse.

This multicentre prospective cohort study categorized patients with UC into those who underwent early (within 6 months of diagnosis) and late (6 months after diagnosis) thiopurine therapy to determine the effectiveness of early thiopurine treatment. The researchers used multivariate Cox proportional hazards regression to identify the independent predictors of the outcomes.

“Thiopurines play an important role in the management of steroid-refractory and steroid-dependent UC,” the researchers said. “However, the effectiveness of the early use of thiopurines in UC remains controversial.”