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Efficacy of thiopurines and adalimumab in preventing Crohn's disease recurrence in high-risk patients - a POCER study analysis.
- Source :
-
Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2015 Oct; Vol. 42 (7), pp. 867-79. Date of Electronic Publication: 2015 Aug 28. - Publication Year :
- 2015
-
Abstract
- Background: Crohn's disease recurs in the majority of patients after intestinal resection.<br />Aim: To compare the relative efficacy of thiopurines and anti-TNF therapy in patients at high risk of disease recurrence.<br />Methods: As part of a larger study comparing post-operative management strategies, patients at high risk of recurrence (smoker, perforating disease, ≥2nd operation) were treated after resection of all macroscopic disease with 3 months metronidazole together with either azathioprine 2 mg/kg/day or mercaptopurine 1.5 mg/kg/day. Thiopurine-intolerant patients received adalimumab induction then 40 mg fortnightly. Patients underwent colonoscopy at 6 months with endoscopic recurrence assessed blind to treatment.<br />Results: A total of 101 patients [50% male; median (IQR) age 36 (25-46) years] were included. There were no differences in disease history between thiopurine- and adalimumab-treated patients. Fifteen patients withdrew prior to 6 months, five due to symptom recurrence (of whom four were colonoscoped). Endoscopic recurrence (Rutgeerts score i2-i4) occurred in 33 of 73 (45%) thiopurine vs. 6 of 28 (21%) adalimumab-treated patients [intention-to-treat (ITT); P = 0.028] or 24 of 62 (39%) vs. 3 of 24 (13%) respectively [per-protocol analysis (PPA); P = 0.020]. Complete mucosal endoscopic normality (Rutgeerts i0) occurred in 17/73 (23%) vs. 15/28 (54%) (ITT; P = 0.003) and in 27% vs. 63% (PPA; P = 0.002). The most advanced disease (Rutgeerts i3 and i4) occurred in 8% vs. 4% (thiopurine vs. adalimumab).<br />Conclusions: In Crohn's disease patients at high risk of post-operative recurrence adalimumab is superior to thiopurines in preventing early disease recurrence.<br /> (© 2015 John Wiley & Sons Ltd.)
- Subjects :
- Adult
Aged
Azathioprine adverse effects
Colonoscopy methods
Crohn Disease diagnosis
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Male
Mercaptopurine adverse effects
Metronidazole adverse effects
Middle Aged
Postoperative Period
Recurrence
Risk Factors
Treatment Outcome
Tumor Necrosis Factor-alpha antagonists & inhibitors
Tumor Necrosis Factor-alpha immunology
Adalimumab therapeutic use
Azathioprine administration & dosage
Crohn Disease prevention & control
Crohn Disease surgery
Mercaptopurine administration & dosage
Metronidazole administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2036
- Volume :
- 42
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Alimentary pharmacology & therapeutics
- Publication Type :
- Academic Journal
- Accession number :
- 26314275
- Full Text :
- https://doi.org/10.1111/apt.13353