The thiopurine analogs azathioprine and mercaptopurine have proven efficacy in inducing and maintaining clinical remission in Crohn's disease (CD).
Their impact on the long-term need for surgery is uncertain since studies have reported conflicting results.
Dr Richard Pollok and colleagues from the United Kingdom evaluated evidence of the published literature regarding those studies assessing the impact of thiopurines on the risk of first surgical resection in CD.
The team systematically searched Medline, EMBASE, CINAHL, and hand searched reference lists of identified articles, without language restrictions in 2013.
|Thiopurine use is associated with a 40% lowered risk of surgical resection in Crohn's|
|American Journal of Gastroenterology|
The research team identified 17 retrospective observational studies representing 21,632 participants that met the inclusion criteria.
Of these 10 studies involving 12,586 participants provided data on the hazard ratio (HR) and 95% confidence intervals (CIs) evaluating use of TPs and surgical risk.
The researchers found that the combined pooled hazard ratio of first intestinal resection with thiopurine use was 0.59.
Dr Pollock's team concludes, "Thiopurine use is associated with a 40% lowered risk of surgical resection in patients with CD."
"Despite significant reductions in rates of surgical resection in patients with CD over the last 5 decades and increasing use of thiopurines, a large proportion of patients with CD still require resectional surgery."