IOIBD questionnaire on the clinical use of azathioprine, 6-mercaptopurine,cyclosporin A and methotrexate in the treatment of inflammatory bowel diseases

Objective To obtain information on the clinical experience with azathioprin e (AZA), 6-mercaptopurine (6-MP), cyclosporin A (CyA) and methotrexate (MTX ) in the treatment of patients with inflammatory bowel disease (IBD) by gas troenterologists and internists in different countries. Design A questionnaire designed by the International Organization for the S tudy of Inflammatory Bowel Disease (IOIBD) was mailed to 300 gastroenterolo gists, living in North America (n = 76) and Europe (n = 224) (12 countries) , to obtain information on clinical experience. Participants More than half of the respondents (168/298; 56.4%) worked in u niversity hospitals and 58/298 (19.5%) in general (non-university) hospital s. Two-thirds (65%) had more than 10 years' experience in gastroenterology. Results The respondents had personal experience with AZA (88.4%), 6-MP (33. 3%), CyA (48.7%) and MTX (36.3%). AZA was prescribed more frequently in Eur ope (92.6%) than in North America (74.2%) (P = 0.0002), 6-MP less frequentl y by the European than the North American respondents (23.8 and 53.3% respe ctively, P = 0.0001). Two-thirds (69.7%) usually prescribed AZA together wi th steroids to Crohn's disease patients; 62.4% of the respondents prescribe d AZA for periods longer than 24 months. For ulcerative colitis, 77.9% had experience with AZA (Europe > North America, P = 0.0001). AZA had been pres cribed by 69 respondents to pregnant patients, without apparent toxicity. A cute pancreatitis had been observed after AZA by 56.7% respondents; 25 mali gnancies were mentioned (six lymphoma, three leukaemia, three colon cancer, four renal carcinoma, nine others), CyA had been prescribed in acute ulcer ative colitis by 140/291 respondents (North America 45.1%, Europe 49.1%); o f all respondents 63.9% treated < 5 patients with CyA, 36.1% 6-20 cases. Cy A results were considered good in 29.5%, acceptable but with recurrences in 58.6%, and poor in 14.3%. MTX was prescribed in North America by 47.8% of the respondents, and by 33.9% in Europe (not significant). Several signific ant differences were observed between the prescription behaviour of respond ents working at university hospitals and non-university hospitals, in parti cular in relation to participation in clinical trials. Conclusions Considerable experience exists in the use of immunosuppressive therapy in IBD; however, differential prescription behaviour exists in the choice of immunosuppressives between North America and Europe. These IOIBD study results may contribute to a better insight in the daily use of immuno suppressive agents in IBD by gastroenterologists and other specialists, (C) 2000 Lippincott Williams & Wilkins.