Thiopurines halve risk of repeat Crohn's disease surgery

Last Updated: 2010-01-14 16:32:37 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - After a first surgical resection for Crohn's disease, long-term treatment with thiopurines appears to cut the risk of subsequent intestinal surgery by nearly 60%, Austrian researchers reported online December 15th in the American Journal of Gastroenterology.

They were "facing a situation where evidence on the influence of azathioprine and 6-mercaptopurine on the natural course of Crohn's disease in adult patients is controversial," the researchers said. Therefore, they reviewed the outcomes of 326 patients who had surgery for Crohn's disease, 161 of whom (49%) had taken either azathioprine or 6-mercaptopurine postoperatively.

As co-author Dr. Walter Reinisch of the Medical University of Vienna and colleagues report, 151 patients (46.3%) had surgery for recurrent disease at a median of 71 months after the initial operation.

Overall, 38.5% of the thiopurine group had surgical recurrence, significantly fewer than the 53.9% in the non-treatment group. Patients treated with thiopurines for at least 36 months were at significantly lower risk for more surgery compared to those who had received shorter treatment or no treatment (hazard ratio, 0.41, p < 0.004).

The researchers also examined the influence of smoking in the 273 patients with available data. At a median of 11.5 years, the 139 smokers in the group had an increased risk of surgical recurrence compared with the 134 non-smokers (HR, 1.6, p < 0.008).

The researchers conclude that long-term therapy with azathioprine or 6-mercaptopurine is "an independent negative predictor of surgical recurrence in patients with Crohn's disease after first intestinal surgery."

In an email, Dr. Reinisch told Reuters Health that the finding "punctuates the newly upcoming guidelines of the European Crohn's and Colitis Organization," which advise that thiopurines be given to high-risk patients to prevent recurrence.

Am J Gastroenterol 2009.