Differences in the risk of clinical failure between thiopurine and methotrexate in bio-naïve patients with Crohn’s disease: a Korean nationwide population-based study

• Published in: Therapeutic advances in gastroenterology 2024-01, Vol.17, p.17562848241248321-17562848241248321
• Main Authors: Jun, Yu Kyung, Ji, Eunjeong, Yang, Hye Ran, Choi, Yonghoon, Shin, Cheol Min, Park, Young Soo, Kim, Nayoung, Lee, Dong Ho, Yoon, Hyuk
• Format: Article
• Language: English
• Subjects: Original Research; Population-based studies; Remission (Medicine)
• ISSN: 1756-2848; 1756-283X; 1756-2848
• DOI: 10.1177/17562848241248321

Background: Although immunomodulators are widely prescribed in patients with Crohn’s disease (CD), it is unclear whether there is a difference in treatment outcomes between thiopurines and methotrexate (MTX). Objective: To compare the risk of clinical failure between thiopurines and MTX in bio-naïve patients with CD. Design: Nationwide, population-based study. Methods: We used claims data from the Korean National Health Insurance Service. After inverse probability of treatment weighting, logistic regression and Cox proportional hazard analyses were used to evaluate the risk of clinical failure in bio-naïve patients with CD treated with thiopurine (thiopurine group) or MTX (MTX group). Results: Overall, 10,296 adult and pediatric patients with CD [9912 (96.3%) and 384 (3.7%) in the thiopurine and MTX groups, respectively] were included. The odds ratios (ORs) of failure to induce remission were significantly higher in the MTX group than in the thiopurine group [adjusted OR (aOR), 1.115; 95% confidence interval (CI), 1.045–1.190; p = 0.001]. However, the opposite result was observed only in patients without concomitant steroid use: the MTX group had a lower risk of induction failure than the thiopurine group (aOR, 0.740; 95% CI, 0.673–0.813; p