title: Thiopurines are associated with a reduction in surgical re-resections in patients with Crohn's disease: a long-term follow-up study in a regional and academic cohort.
abstract: BACKGROUND
  Combination therapy of thiopurines and anti-tumor necrosis factor alpha (TNF-α) antibodies is the most effective medical treatment of Crohn's disease (CD). Data on thiopurines and anti-TNF-α antibodies in preventing surgical recurrence (need for re-resection) of CD are scarce. Therefore, we analyzed which factors were involved in surgical recurrence of CD in a large cohort of patients with CD operated in a regional and a university hospital.
  
  
  METHODS
  This is a retrospective cohort study of 567 patients who underwent surgery for CD. Clinical data and risk factors for surgical recurrence were analyzed, focusing on medical therapy and hospital type.
  
  
  RESULTS
  Overall, 237 (41.8%) patients developed a surgical recurrence, after a median of 70 (2-482) months. Before surgical recurrence, 235 patients (41.4%) and 116 patients (20.5%) used thiopurines and anti-TNF-α antibodies, respectively. Multivariate analysis identified 3 independent risk factors associated with surgical recurrence of CD. A higher risk was seen in patients with colonic disease compared with patients with ileal disease (hazard ratio, 1.56; 95% confidence interval, 1.10-2.21; P = 0.012) and in patients using multiple types of medication (hazard ratio, 1.38; 95% confidence interval, 1.25-1.54; P < 0.001). However, a lower risk was seen in patients using thiopurines (hazard ratio, 0.51; 95% confidence interval, 0.34-0.77; P = 0.001).
  
  
  CONCLUSIONS
  Thiopurines are effective in preventing surgical recurrence of CD. The role of anti-TNF-α antibodies seems promising as well. Combination therapy of thiopurines and anti-TNF-α antibodies for prevention of surgical recurrence of CD should be studied in a randomized trial.
authors.affiliation: *Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands; †Department of Surgery, Scheper Ziekenhuis, Emmen, the Netherlands; ‡Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands; §Wenckebach Institute, Post Graduate School of Medicine, University Medical Center Groningen, Groningen, the Netherlands; Departments of ‖Surgery, and ¶Gastroenterology, Medical Center Leeuwarden, Leeuwarden, the Netherlands; and **Department of Surgery, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: van Loo
authors.forename: Ninke W
authors.initials: NW
authors.lastname: Vosseberg
authors.forename: Frans
authors.initials: F
authors.lastname: van der Heide
authors.forename: Jean-Pierre E N
authors.initials: JP
authors.lastname: Pierie
authors.forename: Klaas
authors.initials: K
authors.lastname: van der Linde
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
authors.forename: Gerard
authors.initials: G
authors.lastname: Dijkstra
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Nieuwenhuijs
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D055502:Secondary Prevention; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D004338:Drug Combinations; D014409:Tumor Necrosis Factor-alpha; D015122:Mercaptopurine; D001379:Azathioprine