%0 Journal Article %J Inflamm Bowel Dis %D 2016 %T Effect of Early Versus Late Azathioprine Therapy in Pediatric Ulcerative Colitis. %A Aloi, Marina %A DʼArcangelo, Giulia %A Bramuzzo, Matteo %A Gasparetto, Marco %A Martinelli, Massimo %A Alvisi, Patrizia %A Illiceto, Maria Teresa %A Valenti, Simona %A Distante, Manuela %A Pellegrino, Salvatore %A Gatti, Simona %A Arrigo, Serena %A Civitelli, Fortunata %A Martelossi, Stefano %X

BACKGROUND: We aimed at describing the efficacy of azathioprine (AZA) in pediatric ulcerative colitis, comparing the outcomes of early (0-6 months) versus late (6-24 months) initiation of therapy.

METHODS: Children with ulcerative colitis treated with AZA within 24 months of diagnosis were included. Corticosteroid (CS)-free remission and mucosal healing (MH), assessed by endoscopy or fecal calprotectin, at 12 months were the primary outcomes. Patients were also compared for CS-free remission and MH, need for treatment escalation or surgery, number of hospitalizations, and adverse events during a 24-month follow-up.

RESULTS: A total of 121 children entered the study (median age 10.5 ± 4.0 years, 59% girls). Seventy-six (63%) started AZA between 0 and 6 months (early group) and 45 (37%) started between 6 and 24 months (late group). Seventy-five percent and 53% of patients in the early and late group, respectively, received CS at the diagnosis (P = 0.01). CS-free remission at 1 year was achieved by 30 (50%) of the early and 23 (57%) of the late patients (P = 0.54). MH occurred in 37 (37%) patients at 1 year, with no difference between the 2 groups (33% early, 42% late; P = 0.56). No difference was found for the other outcomes.

CONCLUSIONS: Introduction of AZA within 6 months of diagnosis seems not more effective than later treatment to achieve CS-free remission in pediatric ulcerative colitis. MH does not depend on the timing of AZA initiation; however, because of the incomplete comparability of the 2 groups at the diagnosis and the use of fecal calprotectin as a surrogate marker of MH, our results should be further confirmed by prospective studies.

%B Inflamm Bowel Dis %V 22 %P 1647-54 %8 2016 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27271489?dopt=Abstract %R 10.1097/MIB.0000000000000828