Impact of thiopurines and anti-tumour necrosis factor therapy on hospitalisation and long-term surgical outcomes in ulcerative colitis

Table 1 Summary of key research investigating impact of thiopurines and tumour necrosis factor inhibitors therapy on long-term surgical outcomes in ulcerative colitis

	Ref.	Study design	Population	n	Key findings
Thiopurines	Ardizzone et al[11]	RCT comparing AZA vs 5-ASA	Steroid dependent UC	72	No difference in colectomy rates at 6 mo between AZA and 5-ASA groups
	Kaplan et al[13]	Population based time trends analysis of colectomy rates	Unselected UC	N/A	Reduction in elective colectomy rates of 7.4% per year
					Doubling of TP use over the study period
					Emergency colectomy rates remain static
	Targownik et al[14]	Population based analysis of colectomy rates	Unselected UC	3752	10.4% colectomy rate at 10 yr post diagnosis
					> 16 wk TP therapy associated with reduced colectomy requirement
	Chhaya et al[15]	Population based time trends analysis of colectomy rates	Unselected UC	8673	TP use > 12 mo associated with a 71% reduction in risk of colectomy
					Early TP use not associated with added benefit
					No significant change in colectomy rates over study period
	Cañas-Ventura et al[16]	Retrospective descriptive cohort study of UC patients receiving AZA	Unselected UC	1334	5 yr colectomy rate at 8.8%
					TP use within 33 mo of diagnosis associated with increased risk of colectomy
aTNF	Sjöberg et al[24]	Multi-centre retrospective analysis of IFX rescue therapy	Acute severe UC	211	64%, 59% and 53% colectomy-free survival at years 1, 3, 5
					Majority of colectomies within first 2 wk of IFX therapy
	Gustavsson et al[26]	RCT comparing IFX rescue therapy vs placebo	Acute severe UC	45	3 yr colectomy free survival 50%
	Laharie et al[29]	Head to head RCT comparing IFX vs CSA as rescue therapy	Acute severe UC	115	No significant differences in colectomy rates between two therapies at 3 mo
	Sandborn et al[19]	ACT 1 and 2 RCT of IFX vs placebo	Moderate to severe UC	728	Colectomy rate significantly lower in IFX group (10% vs 17%) at 54 wk
	Feagan et al[41]	ULTRA 1 and 2 RCT of ADA vs placebo	Moderate to severe UC	963	Very low colectomy rates reported at 52 wk (approximately 4%)
					No difference in colectomy rates between ADA and placebo
	Reich et al[45]	Time trends analysis of colectomy rates following introduction of IFX	Unselected UC	481	19% annual decrease in elective colectomy in biologic era
					15% annual decrease in emergency colectomy in biologic era
	Costa et al[50]	Meta-analysis of aTNF use in UC	Moderate to severe UC	836	Reduced risk of surgery at 1 yr in patient treated with IFX compared to placebo (OR = 0.55)
					NNT was 11

UC: Ulcerative colitis; aTNF: Tumour necrosis factor inhibitors; RCT: Randomised controlled trial; AZA: Azathioprine; TP: Thiopurine; 5-ASA: 5-aminosalicylic acid; IFX: Infliximab; CSA: Ciclosporin; ADA: Adalimumab; NNT: Number needed to treat; N/A: Not applicable; ACT: Active ulcerative colitis trials; ULTRA: Ulcerative colitis long-term remission and maintenance with adalimumab.