Azathioprine as a postoperative prophylaxis reduces symptoms in aggressive Crohn's disease.
OBJECTIVE
Recurrence of Crohn's disease (CD) after surgery is common. Azathioprine/6-mercaptopurine (Aza/6-MP) is effective in controlling medically induced remission but, so far, has only been sparsely investigated after surgically induced remission. This study comprises a subset of CD patients considered to have an aggressive disease course and chosen for treatment with Aza postoperatively.


METHODS
In 1989-2000, a total of 100 patients with CD were given Aza/6-MP as a postoperative prophylaxis. Fourteen Aza/6-MP-intolerant patients were compared with 28 Aza-tolerant patients, matched for gender, age, and duration of disease. Patients were prospectively registered for symptoms using a modified Crohn's disease activity index (CDAI) and perceived health was assessed on a visual analogue scale (VAS). The primary outcome variable was the modified CDAI postoperatively integrated over time; other variables were time to first relapse (modified CDAI >or= 150), time to first repeated surgery, number of courses of steroids, and repeated surgery per year of follow-up. Patients were followed for a median of 84.7 months (23.2-140).


RESULTS
The modified CDAI integrated over time was 93 for Aza-treated patients compared with 184 for controls (p=0.01) and time to first relapse was 53 and 24 months, respectively (p<0.05). Aza-treated patients needed fewer courses of corticosteroids (p=0.05) compared with controls. Perceived health did not differ between the groups, nor did need of repeated surgery. Time to first repeat operation was 53 and 37 months, respectively.


CONCLUSIONS
In CD patients considered to have an aggressive disease course, Aza reduced symptoms after surgery and prolonged the time to symptomatic relapse. The findings support a role for Aza as a postoperative maintenance treatment in CD.
Myrelid
Pär
P
Department of Surgery, Unit of Colorectal Surgery, Linköping University Hospital, Sweden. par.myrelid@lio.se
Svärm
Susanne
S
Andersson
Peter
P
Almer
Sven
S
Bodemar
Göran
G
Olaison
Gunnar
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation
D015122:Mercaptopurine; D001379:Azathioprine