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Dr Laurent Peyrin-Biroulet and colleagues from Belgium evaluated the efficacy and safety of purine analogs (azathioprine and mercaptopurine) in the prevention of postoperative recurrence in Crohn's disease.
The team searched MEDLINE, the Cochrane Library, and EMBASE.
The team's primary end points included clinical and endoscopic recurrence at 1 and 2 years, and safety were analyzed by the methods of Peto and Der Simonian and Laird.
 | | Purine analogs were more effective in preventing clinical recurrence at 1 year | | American Journal of Gastroenterology |
The researchers enrolled 433 patients in 4 controlled trials and compared azathioprine or mercaptopurine with control arms (placebo with or without antibiotic induction therapy or mesalamine).
In the overall analysis, purine analogs were more effective than control arms in preventing clinical recurrence at 1 year, and 2 years.
The team found that the efficacy of purine analogs was superior to that of placebo for the prevention of clinical and endoscopic recurrence at 1 year.
At 1 year, in the overall analysis, purine analogs were more effective than control arms in preventing severe endoscopic recurrence, but they were not effective in the prevention of very severe recurrence.
The rate of adverse events leading to drug withdrawal was higher in thiopurine-treated patients than in control arms.
Dr Peyrin-Biroulet's team concluded, “Purine analogs are more effective than placebo in preventing both clinical and endoscopic postoperative recurrence in Crohn's disease.”
“However, they are associated with a higher rate of adverse events leading to drug withdrawal.”
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