The researchers retrospectively investigated the efficacy of azathioprine (AZA) for prevention of postoperative recurrence in Crohn's disease (CD).
The findings of the study were published in the November issue of the European Journal of Gastroenterology and Hepatology.
Between 1987 and 1996, 38 patients with CD were treated with AZA to prevent postoperative recurrence.
Of these, 23 had undergone a curative resection with removal of all previously involved parts of the gut.
In the other 15 patients, resection was limited to the parts of the gut macroscopically abnormal at the time of surgery. The parts that were previously involved but normal at this time were conserved.
The operative procedures were ileocolonic resection (n = 18), subtotal colectomy with ileorectal anastomosis (n = 12), coloproctectomy with ileo-anal anastomosis (n = 4) or ileostomy (n = 2), ileal resection (n = 1), and segmental colectomy (n = 1).
Some 12 patients had been treated previously with AZA before surgery. In 26 patients, AZA was started within the 2 months following surgery.
The median duration of postoperative follow-up was 29 months.
|CD recurrence at 2 years:|
With postoperative AZA: 16%
Without AZA: 40%
| European Journal of Gastroenterology & Hepatology |
The researchers found that the probabilities of clinical recurrence were 9%, 16%, and 28% at 1, 2, and 3 years, respectively.
For the 25 patients who had a colonoscopy or a small bowel barium X-ray during the follow-up, probabilities of anatomical recurrence were 16%, 36%, and 59% at 1, 2, and 3 years, respectively.
The probability of anatomical recurrence was significantly higher in patients who had segments of the gut previously involved but not removed because they were macroscopically normal at the time of surgery.
Emmanuel Cuillerier, of the Saint-Louis Hospital, Paris, said on behalf of the group, "In patients treated with AZA, the rate of postoperative endoscopic recurrence was lower than that previously reported in untreated patients."
"Our results suggest that AZA should be evaluated prospectively for prevention of postoperative CD recurrence, at least in high-risk patients," it was concluded.
In an accompanying leading article, Simon Travis, of the John Radcliffe Hospital, Oxford, England, comments, "The clinical relapse rate after surgery for Crohn's disease is about 40% at 2 years, in people who receive no postoperative prophylaxis."
"Thiopurines (azathioprine and 6-mercaptopurine) are likely to be the most effective pharmacotherapy for preventing postoperative relapse: about 4 patients need to be treated for 2 years to prevent one clinical relapse," he added.