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Timing and duration of thiopurine treatment influences resection in Crohn's

The most recent issue of the American Journal of Gastroenterology examines the impact of timing and duration of thiopurine treatment on first intestinal resection in Crohn's disease.

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The efficacy of thiopurines in altering the risk of surgery in Crohn's disease (CD) remains controversial.

Dr Richard Pollok and colleagues from the United Kingdom evaluated the impact of thiopurines therapy, optimal timing, and duration of thiopurines therapy on first intestinal resection rates using a population-based cohort.

The researchers constructed a population-based cohort of incident cases of CD between 1989 and 2005.

The research team used the Kaplan–Meier analysis to calculate time trends in thiopurines use and first intestinal resection in 3 groups defined by time period of diagnosis, including 1989–1993, 1994–1999, and 2000–2005 as groups A, B, and C, respectively.

The research team quantified impact of duration and timing of thiopurines treatment on likelihood of surgery using Cox regression and propensity score matching.

The researchers identified 5,640 eligible patients with CD.

Patients treated with at least 6 months of thiopurines therapy had a 44% reduction in the risk of surgery
Alimentary Pharmacology & Therapeutics

The team found that 5-year cumulative probability of thiopurines use increased from 12%, 18%, to 25% while probability of first intestinal resection decreased from 15%, 12% to 9% in groups A, B, and C, respectively.

Patients treated with at least 6 months of thiopurines therapy had a 44% reduction in the risk of surgery, and those receiving at least 12 months of thiopurines therapy had a 69% reduction in the risk of surgery.

The research team observed that early treatment vs. late treatment with thiopurines showed no additional benefit in reducing risk of surgery.

Dr Pollock and colleagues concludes, "Over the past 20 years, thiopurines use has doubled, whereas intestinal surgery has fallen by one-third among the UK population of Crohn's patients."

"Prolonged exposure is associated with a reduced likelihood of surgery whereby more than 12 months thiopurines therapy reduces the risk of first intestinal surgery 2-fold."

"However, early initiation of thiopurines treatment offered no apparent additional benefit."

Am J Gastroenterol 2014; 109:409–416
18 March 2014

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