Thiopurines Maintenance Therapy in Children With Ulcerative Colitis: A Multicenter Retrospective Study

Firas Abu Hanna*, Ohad Atia, Anat Yerushalmy Feler, Dror Shouval, Batia Weiss, Hadeel Mresat, Ramit Magen-Rimon, Eyal Zifman, Dan Turner, Firas Rinawi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background and Aims: Thiopurines are an established treatment for pediatric ulcerative colitis (UC). However, data regarding safety and efficacy are lacking. We aimed to determine short and long-term outcome following thiopurines use in children with UC. Methods: We conducted a retrospective review of children (2-18 years) with UC treated with thiopurines between January 2008 and January 2019 at 7 medical centers in Israel. The primary outcome was corticosteroid (CS)-free clinical remission at week 52 following thiopurines initiation without the need for rescue therapy (infliximab, calcineurin inhibitors, or colectomy). Results: A total of 133 children were included [median age at diagnosis of 12.4 (interquartile range 11.0-15.8) years, 30 (23%) left-sided colitis, 113 (85%) with moderate or severe disease at diagnosis]. At diagnosis 58 patients (44%) were treated with 5-aminosalicylates and 72 (54%) with CS. Sixty patients (45%) received thiopurines as 1st line maintenance therapy. Seventy-four patients (56%) had CS-free clinical remission at week 52 without rescue therapy. Predictors of clinical remission were not identified. In a sub-analysis among patients with steroid-responsive moderate to severe UC, 59 (55%) patients achieved this outcome. The likelihood of remaining free of rescue therapy among thiopurines-treated patients was 83%, 62%, 45%, and 37% at 1, 2, 3, and 4 years, respectively. Conclusion: More than half of children with UC starting thiopurines without previous or concomitant biologic therapy have CS-free clinical remission at 52 weeks later without the need for rescue therapy. Thiopurines are effective in pediatric UC and could be considered prior to biologics.

Original languageAmerican English
Pages (from-to)505-511
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number4
StatePublished - 1 Oct 2023

Bibliographical note

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  • children
  • thiopurines
  • ulcerative colitis


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