Azathioprine for Maintenance of Remission in Crohn's Disease: Benefits Outweigh the Risk of Lymphoma

Gastroenterology. 2000 Jun;118(6):1018-24. doi: 10.1016/s0016-5085(00)70353-2.

Abstract

Background & aims: Azathioprine is a commonly used and effective treatment for maintenance of remission for patients with steroid-dependent Crohn's disease (CD). However, azathioprine therapy is associated with an increased risk of non-Hodgkin's lymphoma. The objective of this analysis was to determine the impact of azathioprine therapy on survival and quality-adjusted life expectancy after accounting for both the benefits of therapy and potential increased risk of lymphoma.

Methods: A decision analysis using a Markov model depicting the natural history of alternative management strategies for maintenance of remission in patients with CD was performed.

Results: In the base-case analysis, treatment of CD patients with a steroid-induced remission with azathioprine resulted in an average increase in life expectancy of 0.04 years and 0.05 quality-adjusted years. The incremental gain in life expectancy decreased with increasing patient age and increasing risk of lymphoma.

Conclusions: Therapy with azathioprine to preserve remission in patients with CD results in increased quality-adjusted life expectancy. This increase was greatest in young patients who have the lowest baseline risk of non-Hodgkin's lymphoma and who have the greatest life expectancy in the absence of a CD-related death.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Azathioprine / administration & dosage*
  • Azathioprine / adverse effects
  • Crohn Disease / drug therapy*
  • Crohn Disease / mortality*
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects
  • Incidence
  • Life Expectancy
  • Lymphoma, Non-Hodgkin / mortality*
  • Markov Chains*
  • Middle Aged
  • Quality-Adjusted Life Years
  • Remission Induction
  • Risk Factors
  • Survival Analysis

Substances

  • Immunosuppressive Agents
  • Azathioprine