Tacrolimus therapy as an alternative to thiopurines for maintaining remission in patients with refractory ulcerative colitis

Shuji Yamamoto, Hiroshi Nakase, Minoru Matsuura, Satohiro Masuda, Ken Ichi Inui, Tsutomu Chiba

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

BACKGROUND: Although the efficacy of tacrolimus for inducing remission of refractory ulcerative colitis (UC) is established, its efficacy for maintaining remission of UC has not been evaluated. AIM: The aim of this study was to evaluate the efficacy of tacrolimus compared with thiopurines for maintaining remission in patients with refractory UC. METHODS: Twenty-four UC patients treated with tacrolimus and 34 treated with thiopurines to maintain remission were enrolled as the tacrolimus group and the thiopurine group, respectively. In the tacrolimus group, 82.8% of the patients were treated with tacrolimus for induction of the remission, whereas 70% of the patients in the thiopurine group were induced remission with either corticosteroid or cytapheresis. Proportions of patients who kept steroid-free remission between the tacrolimus and the thiopurine groups were compared. Maintenance of remission using tacrolimus or thiopurines was defined as no need for other therapies other than aminosalicylates without relapse for at least 3 months. Secondarily, to determine whether the response to thiopurines affects the long-term efficacy of tacrolimus maintenance therapy, the overall cumulative relapse-free survival based on the Kaplan-Meier method was estimated in thiopurine-naive or thiopurine-intolerant patients and thiopurine-refractory ones in the tacrolimus group. RESULTS: Remission was successfully maintained in 17 patients (70.8%) of the tacrolimus group, and 28 patients (82.4%) of the thiopurine group. The overall cumulative relapse-free survival of thiopurine-naive or thiopurine-intolerant patients in the tacrolimus group was similar to that in the thiopurine group, and significantly higher than that of thiopurine- refractory patients in the tacrolimus group. CONCLUSION: Maintenance therapy with tacrolimus for patients with UC could be considered an alternative to thiopurine therapy.

Original languageEnglish
Pages (from-to)526-530
Number of pages5
JournalJournal of Clinical Gastroenterology
Volume45
Issue number6
DOIs
Publication statusPublished - Jul 1 2011

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Tacrolimus
Complementary Therapies
Ulcerative Colitis
Recurrence
Cytapheresis
Remission Induction
Survival
Therapeutics
Adrenal Cortex Hormones

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Tacrolimus therapy as an alternative to thiopurines for maintaining remission in patients with refractory ulcerative colitis. / Yamamoto, Shuji; Nakase, Hiroshi; Matsuura, Minoru; Masuda, Satohiro; Inui, Ken Ichi; Chiba, Tsutomu.

In: Journal of Clinical Gastroenterology, Vol. 45, No. 6, 01.07.2011, p. 526-530.

Research output: Contribution to journalArticle

Yamamoto, Shuji ; Nakase, Hiroshi ; Matsuura, Minoru ; Masuda, Satohiro ; Inui, Ken Ichi ; Chiba, Tsutomu. / Tacrolimus therapy as an alternative to thiopurines for maintaining remission in patients with refractory ulcerative colitis. In: Journal of Clinical Gastroenterology. 2011 ; Vol. 45, No. 6. pp. 526-530.
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abstract = "BACKGROUND: Although the efficacy of tacrolimus for inducing remission of refractory ulcerative colitis (UC) is established, its efficacy for maintaining remission of UC has not been evaluated. AIM: The aim of this study was to evaluate the efficacy of tacrolimus compared with thiopurines for maintaining remission in patients with refractory UC. METHODS: Twenty-four UC patients treated with tacrolimus and 34 treated with thiopurines to maintain remission were enrolled as the tacrolimus group and the thiopurine group, respectively. In the tacrolimus group, 82.8{\%} of the patients were treated with tacrolimus for induction of the remission, whereas 70{\%} of the patients in the thiopurine group were induced remission with either corticosteroid or cytapheresis. Proportions of patients who kept steroid-free remission between the tacrolimus and the thiopurine groups were compared. Maintenance of remission using tacrolimus or thiopurines was defined as no need for other therapies other than aminosalicylates without relapse for at least 3 months. Secondarily, to determine whether the response to thiopurines affects the long-term efficacy of tacrolimus maintenance therapy, the overall cumulative relapse-free survival based on the Kaplan-Meier method was estimated in thiopurine-naive or thiopurine-intolerant patients and thiopurine-refractory ones in the tacrolimus group. RESULTS: Remission was successfully maintained in 17 patients (70.8{\%}) of the tacrolimus group, and 28 patients (82.4{\%}) of the thiopurine group. The overall cumulative relapse-free survival of thiopurine-naive or thiopurine-intolerant patients in the tacrolimus group was similar to that in the thiopurine group, and significantly higher than that of thiopurine- refractory patients in the tacrolimus group. CONCLUSION: Maintenance therapy with tacrolimus for patients with UC could be considered an alternative to thiopurine therapy.",
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T1 - Tacrolimus therapy as an alternative to thiopurines for maintaining remission in patients with refractory ulcerative colitis

AU - Yamamoto, Shuji

AU - Nakase, Hiroshi

AU - Matsuura, Minoru

AU - Masuda, Satohiro

AU - Inui, Ken Ichi

AU - Chiba, Tsutomu

PY - 2011/7/1

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N2 - BACKGROUND: Although the efficacy of tacrolimus for inducing remission of refractory ulcerative colitis (UC) is established, its efficacy for maintaining remission of UC has not been evaluated. AIM: The aim of this study was to evaluate the efficacy of tacrolimus compared with thiopurines for maintaining remission in patients with refractory UC. METHODS: Twenty-four UC patients treated with tacrolimus and 34 treated with thiopurines to maintain remission were enrolled as the tacrolimus group and the thiopurine group, respectively. In the tacrolimus group, 82.8% of the patients were treated with tacrolimus for induction of the remission, whereas 70% of the patients in the thiopurine group were induced remission with either corticosteroid or cytapheresis. Proportions of patients who kept steroid-free remission between the tacrolimus and the thiopurine groups were compared. Maintenance of remission using tacrolimus or thiopurines was defined as no need for other therapies other than aminosalicylates without relapse for at least 3 months. Secondarily, to determine whether the response to thiopurines affects the long-term efficacy of tacrolimus maintenance therapy, the overall cumulative relapse-free survival based on the Kaplan-Meier method was estimated in thiopurine-naive or thiopurine-intolerant patients and thiopurine-refractory ones in the tacrolimus group. RESULTS: Remission was successfully maintained in 17 patients (70.8%) of the tacrolimus group, and 28 patients (82.4%) of the thiopurine group. The overall cumulative relapse-free survival of thiopurine-naive or thiopurine-intolerant patients in the tacrolimus group was similar to that in the thiopurine group, and significantly higher than that of thiopurine- refractory patients in the tacrolimus group. CONCLUSION: Maintenance therapy with tacrolimus for patients with UC could be considered an alternative to thiopurine therapy.

AB - BACKGROUND: Although the efficacy of tacrolimus for inducing remission of refractory ulcerative colitis (UC) is established, its efficacy for maintaining remission of UC has not been evaluated. AIM: The aim of this study was to evaluate the efficacy of tacrolimus compared with thiopurines for maintaining remission in patients with refractory UC. METHODS: Twenty-four UC patients treated with tacrolimus and 34 treated with thiopurines to maintain remission were enrolled as the tacrolimus group and the thiopurine group, respectively. In the tacrolimus group, 82.8% of the patients were treated with tacrolimus for induction of the remission, whereas 70% of the patients in the thiopurine group were induced remission with either corticosteroid or cytapheresis. Proportions of patients who kept steroid-free remission between the tacrolimus and the thiopurine groups were compared. Maintenance of remission using tacrolimus or thiopurines was defined as no need for other therapies other than aminosalicylates without relapse for at least 3 months. Secondarily, to determine whether the response to thiopurines affects the long-term efficacy of tacrolimus maintenance therapy, the overall cumulative relapse-free survival based on the Kaplan-Meier method was estimated in thiopurine-naive or thiopurine-intolerant patients and thiopurine-refractory ones in the tacrolimus group. RESULTS: Remission was successfully maintained in 17 patients (70.8%) of the tacrolimus group, and 28 patients (82.4%) of the thiopurine group. The overall cumulative relapse-free survival of thiopurine-naive or thiopurine-intolerant patients in the tacrolimus group was similar to that in the thiopurine group, and significantly higher than that of thiopurine- refractory patients in the tacrolimus group. CONCLUSION: Maintenance therapy with tacrolimus for patients with UC could be considered an alternative to thiopurine therapy.

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