Abstract
Abstract
Background
The Ulcerative Colitis (UC) and Chron’s Disease (CD) are two debilitating Inflammatory Bowel Diseases (IBD) with an immense negative impact on patients’ health-related quality of life (HRQoL). Although several studies have examined the efficacy of different drugs in the management of IBD, none of these studies has assessed their impact on HRQoL among IBD patients in low incidence areas, such as Saudi Arabia. Therefore, the aim of this study was to examine the impact of Azathioprine, which is one of the commonly utilised immunosuppressive drugs, on HRQoL among a sample of IBD patients in Saudi Arabia.
Methods
This was a single-centre retrospective cohort study in which adult patients (≥18 years) with a confirmed diagnosis of UC or CD and no malignancies were identified in the hospital IBD registry. Patients’ HRQoL was assessed using the EuroQol five-dimensions- 3-level (EQ5D) at baseline as well as six months after initiation of therapy. The overall HRQoL was assessed using the Visual Analogue Scale (VAS) of the EQ5D. Multiple linear regression analysis was conducted to examine the impact of Azathioprine on patients’ EQ5D VAS scores at the six-month follow-up visit controlling for their baseline EQ5D VAS scores, duration of illness, sex, diagnosis (CD or UC), comorbidities, number of prescription medications, and the use of biologics (e.g., infliximab, adalimumab), 5-aminosalicylic acid (5-ASA), and steroids.
Results
Out of 220 IBD patients who were recruited, 160 patients met the inclusion criteria and were included in the study. About 56% of the patients had CD and 44% had UC. The mean age of the patients was 27 years and 54% of them were female. The majority of the patients (77%) did not have any comorbidities. Approximately 63% of the patients were on Azathioprine, and only 4% of them were on Azathioprine monotherapy. The majority of those on Azathioprine were on combination therapy with 5-ASA (78%), steroids (80%), and biologics (69%). Patients on Azathioprine were more likely to report higher overall HRQoL scores at the six-month follow-up visit compared with their counterparts on other therapies (β = 9.35; 95% CI: 0.486–18.22; p = 0.003).
Conclusion
The use of Azathioprine was associated with a positive impact on IBD patients’ HRQoL controlling for their baseline overall HRQoL scores as well as a myriad of covariates. Future studies should examine the cost-effectiveness of Azathioprine in comparison to other therapeutic agents in the management of IBD.