Azathioprine for maintenance of remission in Crohn's disease: Benefits outweigh the risk of lymphoma

Background & Aims: Azathioprine is a commonly used and effective treatment for maintenance of remission for patients with steroid-dependent Crohn's di sease (CD). However, azathioprine therapy is associated with an increased r isk of non-Hodgkin's lymphoma. The objective of this analysis was to determ ine the impact of azathioprine therapy on survival and quality-adjusted lif e expectancy after accounting for both the benefits of therapy and potentia l increased risk of lymphoma. Methods: A decision analysis using a Markov m odel depicting the natural history of alternative management strategies for maintenance of remission in patients with CD was performed. Results: In th e base-case analysis, treatment of CD patients with a steroid-induced remis sion with azathioprine resulted in an average increase in life expectancy o f 0.04 years and 0.05 quality-adjusted years. The incremental gain in life expectancy decreased with increasing patient age and increasing risk of lym phoma. Conclusions: Therapy with azathioprine to preserve remission in pati ents with CD results in increased quality-adjusted life expectancy. This in crease was greatest in young patients who have the lowest baseline risk of non-Hodgkin's lymphoma and who have the greatest life expectancy in the abs ence of a CD-related death.