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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 azathioprine (AZA), 6‐mercaptopurine (6‐MP), cyclosporin A (CyA) and methotrexate (MTX) in the treatment of patients with inflammatory bowel disease (IBD) by gastroenterologists and internists in different countries. Design A questionnaire designed by the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) was mailed to 300 gastroenterologists, 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 university hospitals and 58/298 (19.5%) in general (non‐university) hospitals. 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 Europe (92.6%) than in North America (74.2%) (P = 0.0002), 6‐MP less frequently by the European than the North American respondents (23.8 and 53.3% respectively, P = 0.0001). Two‐thirds (69.7%) usually prescribed AZA together with steroids to Crohn's disease patients; 62.4% of the respondents prescribed 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 prescribed by 69 respondents to pregnant patients, without apparent toxicity. Acute pancreatitis had been observed after AZA by 56.7% respondents; 25 malignancies were mentioned (six lymphoma, three leukaemia, three colon cancer, four renal carcinoma, nine others). CyA had been prescribed in acute ulcerative colitis by 140/291 respondents (North America 45.1%, Europe 49.1%); of all respondents 63.9% treated < 5 patients with CyA, 36.1% 6‐20 cases. CyA 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 significant differences were observed between the prescription behaviour of respondents working at university hospitals and non‐university hospitals, in particular 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 immunosuppressive agents in IBD by gastroenterologists and other specialists. Eur J Gastroenterol Hepatol 12:13‐18 © 2000 Lippincott Williams & Wilkins European Journal of Gastroenterology & Hepatology 2000, 12:13‐18