Azathioprine for maintenance of remission in Crohn's disease: Benefits outweigh the risk of lymphoma
Azathioprine for maintenance of remission in Crohn's disease: Benefits outweigh the risk of lymphoma
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DOI：
10.1016/s0016-5085(00)70353-2
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发表时间：
2000-06-01
期刊：
影响因子：
29.4
通讯作者：
Lichtenstein, GR
中科院分区：
文献类型：
--
作者：
Lewis, JD;Schwartz, JS;Lichtenstein, GR
背景和目标：硫唑嘌呤是一种常用且有效的激素依赖性克罗恩病（CD）患者缓解维持治疗。然而，硫唑嘌呤治疗与非霍奇金淋巴瘤的风险增加有关。本分析的目的是确定硫唑嘌呤治疗对生存率和质量调整后的预期寿命的影响，同时考虑治疗的益处和淋巴瘤的潜在风险增加。研究方法：使用马尔可夫模型进行决策分析，描述CD患者维持缓解的替代管理策略的自然史。结果如下：在基础病例分析中，用硫唑嘌呤治疗类固醇诱导缓解的CD患者，平均预期寿命增加0.04年和0.05质量调整年。随着患者年龄的增加和淋巴瘤风险的增加，预期寿命的增量下降。结论：用硫唑嘌呤维持CD患者的缓解可延长质量调整后的预期寿命。这种增加在非霍奇金淋巴瘤基线风险最低和没有CD相关死亡的预期寿命最长的年轻患者中最大。
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.