No therapy,as yet, has been shown to reliably prevent the evolution of postoperative recurrence of Crohn’s disease.
Daniel Present and colleagues in America compared 6-mercaptopurine (6-MP) and mesalamine with a placebo for the prevention of clinical, endoscopic, and radiographic recurrence of Crohn’s disease after resection and ileocolic anastomosis.
In a double blind, double dummy trial, a total of 131 patients were randomly chosen from five different centers to receive 6-MP (50 mg), mesalamine (3 g), or placebo daily.
Clinical assessments of patients were performed at 7 weeks and then every 3 months; colonoscopy at 6, 12, and 24 months; and small bowel series at 12 and 24 months.
The end points used were the clinical, endoscopic, and radiographic recurrence rates at 24 months.
Clinical recurrence rates (intent to treat) by life-table analysis at 24 months were 50%, 58%, and 77% in patients receiving 6-MP, mesalamine, and placebo, respectively.
|6-MP was more effective than placebo at preventing postoperative recurrence of Crohn's disease.|
Endoscopic recurrence rates were 43%, 63%, and 64%, and radiographic recurrence rates were 33%, 46%, and 49%, respectively.
The researchers found that 6-MP was more effective than placebo at preventing clinical and endoscopic recurrence over 2 years.
Patient withdrawals resulted in 69% of the study population evaluable for the clinical recurrence end point.
The group concluded that 6-MP, 50 mg daily, was more effective than placebo at preventing postoperative recurrence of Crohn’s disease.
They suggested that this should be considered as a maintenance therapy after ileocolic resection.