Thématique :
Originalité :
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Coup de coeur :
The American Journal of Gastroenterology
  2018 Aug;113(8):1206-1216.  
  doi: 10.1038/s41395-018-0108-6.  
  Persistence With Immunomodulator Monotherapy Use And Incidence of Therapeutic Ineffectiveness Among Users of Immunomodulator Monotherapy in IBD  
  Targownik LE, Leung S, Lix LM, Singh H, Bernstein CN  



Immunomodulator (IM)-based monotherapy with thiopurines or methotrexate is being increasingly supplanted in the management of moderate-to-severe IBD by more efficacious biologic agents. However, given their low cost, IMs may still have a selective role in this setting.


We used a Canadian population-based dataset of persons with IBD spanning from 1996 until 2014 to assess the initiation and continued use of IM monotherapy, the incidence of outcomes associated with ineffectiveness (defined as IBD-related hospitalization, IBD-resective surgery, systemic corticosteroid (CS) use, or the need for biologic therapy), and the demographic and disease-related characteristics associated with persistence on IM monotherapy and IBD-associated adverse outcomes.


There were 3312 persons diagnosed with IBD (1480 CD, 1832 ulcerative colitis (UC)) in the study period. The cumulative incidence of IM monotherapy use at 5 years was 46 % for CD and 24.9% for UC. Approximately one-third remained on IM monotherapycontinuously for 5 years or more. Roughly three-quarters of IM users with a history of corticosteroid use had at least a 50% reduction in corticosteroid exposure in the year following IM initiation. Thirty-five percent of those with CD and 30% with UC had not developed evidence of therapeutic ineffectiveness within 5 years of IM initiation; people with no history of prior corticosteroid use, no IBD hospitalizations, and persons with CD initiating IM therapy after age 40 were less likely to have an episode of therapeutic ineffectiveness while on IM monotherapyCONCLUSIONS: Although the majority of persons who are initiated on IM monotherapy discontinue medications and/or have evidence of therapeutic ineffectiveness a significant minority remain free of these outcomes over many years of therapy.


Question posée
Quelle est la fréquence et le devenir des patients recevant un traitement de fond par immunosuppresseur en monothérapie pour une MICI ?
Question posée
L’incidence cumulée des traitements de fond par immunosuppresseur en monothérapie était de 46 % pour la maladie de Crohn et de 24,9% dans la RCH ; 35% des patients avec maladie de Crohn et 30% des patients avec RCH sont restés en rémission durant les 5 premières années de traitement.

Etude en population canadienne.

Un sous-groupe de patients bénéficie du traitement par immunosuppresseur en monothérapie.