title: Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn's disease patients.
abstract: BACKGROUND
  Although the cost of Crohn's disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs. MATERIAL/METHODS We evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2-3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups.
  
  
  RESULTS
  On an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients.
  
  
  CONCLUSIONS
  Patients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.
authors.affiliation: Surgery Department, Inflammatory Bowel Diseases Center, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
authors.forename: Gláucio Silva
authors.initials: GS
authors.lastname: de Souza
authors.forename: Fernando Mendonça
authors.initials: FM
authors.lastname: Vidigal
authors.forename: Liliana Andrade
authors.initials: LA
authors.lastname: Chebli
authors.forename: Tarsila Campanha
authors.initials: TC
authors.lastname: da Rocha Ribeiro
authors.forename: Maria Cristina Vasconcellos
authors.initials: MC
authors.lastname: Furtado
authors.forename: Fábio Heleno
authors.initials: FH
authors.lastname: de Lima Pace
authors.forename: Leonardo Duque
authors.initials: LD
authors.lastname: de Miranda Chaves
authors.forename: Karine Andrade
authors.initials: KA
authors.lastname: de Oliveira Zanini
authors.forename: Pedro Duarte
authors.initials: PD
authors.lastname: Gaburri
authors.forename: Fernando
authors.initials: F
authors.lastname: de Azevedo Lucca
authors.forename: Alexandre
authors.initials: A
authors.lastname: Zanini
authors.forename: Luiz Cláudio
authors.initials: LC
authors.lastname: Ribeiro
authors.forename: Julio Maria Fonseca
authors.initials: JM
authors.lastname: Chebli
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000494:pharmacology* / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D019804:Mesalamine / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*
chemical_list: D019804:Mesalamine; D001379:Azathioprine