Thiopurines are superior to mesalamine for preventing postoperative recurrence in patients with Crohn's disease and two or more risk factors.
Crohn disease
mesalamine
postoperative period
recurrence
thiopurine methyltransferase
Journal
Journal of digestive diseases
ISSN: 1751-2980
Titre abrégé: J Dig Dis
Pays: Australia
ID NLM: 101302699
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
24
08
2021
received:
31
03
2021
accepted:
25
08
2021
pubmed:
29
8
2021
medline:
21
10
2021
entrez:
28
8
2021
Statut:
ppublish
Résumé
To confirm the hypothesis that thiopurines are better than mesalamine for preventing postoperative recurrence of Crohn's disease (CD) in patients with more than two risk factors. In total 87 consecutive CD patients who underwent curative ileocolonic resection and ileocolic anastomosis were retrospectively recruited, including 43 prescribed with thiopurines and 44 with mesalamine after surgery. Four risk factors were predefined for subgroup analyses: smoking, penetrating disease, perianal disease and previous resection. End-points included clinical (Crohn's disease activity index >200) and endoscopic recurrence (Rutgeerts score ≥i2) within 52 weeks. There were no significant differences in clinical (37.2% vs 54.5%, P = 0.105) and endoscopic recurrence (55.8% vs 75.0%, P = 0.060) between the thiopurines and mesalamine groups by week 52. In the subgroup analysis of patients with two or more risk factors, clinical (35.7% vs 81.8%, P = 0.042) and endoscopic recurrence (64.3% vs 100%, P= 0.046) were less frequent in the thiopurine group than the mesalamine group. With one additional risk factor, the risk of endoscopic recurrence in the thiopurines group increased by 2.201-fold (95% confidence interval [CI] 1.178-4.115), adjusted for treatment intervention. While the risk of clinical and endoscopic recurrence in patients treated with mesalamine increased by 3.383-fold and 5.884-fold (95% CI 1.260-9.081 and 1.598-21.662). Three patients treated with thiopurines withdrew for adverse events. Thiopurines may be superior to mesalamine for preventing postoperative recurrence of CD in patients with two or more risk factors. Caution is needed in light of the adverse events caused by thiopurines.
Identifiants
pubmed: 34453408
doi: 10.1111/1751-2980.13047
doi:
Substances chimiques
Mesalamine
4Q81I59GXC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
590-596Subventions
Organisme : National Natural Science Foundation of China
ID : 81870382
Informations de copyright
© 2021 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
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