Meta-analysis: the efficacy of azathioprine and mercaptopurine in ulcerative colitis.

摘要

BACKGROUND: Debate exists regarding to whether thiopurine therapy is as effective in ulcerative colitis (UC) as it is in Crohn's disease. AIM: To review systematically the efficacy of azathioprine (AZA) and mercaptopurine (MP) in UC, and to conduct a meta-analysis of randomized clinical trials evaluating the efficacy of AZA/MP for the induction or maintenance of UC clinical remission. METHODS: Selection of studies: Evaluating AZA/MP for induction and/or maintenance of clinical remission of UC. Randomized-controlled-trials comparing AZA/MP with placebo/5-aminosalicylates were included in the meta-analysis. Search strategy: Electronic and manual. Study quality: Independently assessed by two reviewers. Data synthesis: By 'intention-to-treat'. RESULTS: Thirty noncontrolled studies (1632 patients) were included in the systematic review. Mean efficacy of AZA/MP was 65 for induction and 76 for maintenance of the remission. Seven controlled studies were included in the meta-analysis. (i) Induction of remission: four studies (89 AZA/MP-treated patients) showed mean efficacy of 73 vs. 64 in controls (OR = 1.59; 95 CI = 0.59-4.29). (ii) Maintenance of remission: six studies (124 AZA/MP-treated patients) showed mean efficacy of 60 vs. 37 in controls (OR = 2.56; 95 CI = 1.51-4.34). When only studies comparing AZA/MP vs. placebo were considered, OR was 2.59 (95 CI = 1.26-5.3), absolute risk reduction was 23 and number-needed-to-treat (NNT) to prevent one recurrence was 5. CONCLUSION: Thiopurine drugs (AZA/MP) are more effective than placebo for the prevention of relapse in UC, with an NNT of 5 and an absolute risk reduction of 23.