Postoperative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine, or placebo: A 2-year trial

Hanauer, Stephen B.; Korelitz, Burton I.; Rutgeerts, Paul; Peppercorn, Mark A.; Thisted, Ronald A.; Cohen, Russell D.; Present, Daniel H.

doi:10.1053/j.gastro.2004.06.002

Cited by 427 publications

(264 citation statements)

References 27 publications

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“…One trial from the 1980s demonstrated bene ts from sulfasalazine at doses greater than 3 g daily (239) , but most recent studies have focused on attempts at postoperative prophylaxis with mesalamine. Although early trials have demonstrated bene ts for mesalamine, >3 g daily, at reducing the risk of postoperative recurrence for up to 3 years in subgroups of patients (240) , more recent controlled trials have been less supportive (241,242) . Overall, the ECCO consensus and a North American Pediatric Workshop support a modest overall bene t of approximately 1 in 10 patients (NNT = 10) for mesalamine at delaying / preventing postoperative recurrence (77,238) .…”

Section: Maintenance Therapymentioning

confidence: 99%

“…Budesonide at a dose of 6 mg daily was not e ective at reducing endoscopic recurrences a er 1 year (247) . Recently, several trials have evaluated 6-mercaptopurine (50 mg / day) or azathioprine (2 mg / kg / day), which demonstrated modest bene ts of the immune suppressants compared with placebo and non-signi cant di erences compared with mesalamine 3 g daily (241,248) . A recent trial has demonstrated improved bene t with a combination of metronidazole for 3 months with 1 year of azathioprine (249) .…”

Section: Maintenance Therapymentioning

confidence: 99%

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Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Maintenance Therapymentioning

confidence: 99%

Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…Pre vi o us stu dies ar gu ed the ef fec ti ve ness AZA in pre ven ting en dos co pic prog res si on (with a re duc ti on of 20-30% in the prog res si on ra tes over 1 ye ar) af ter sur gery. 32 In anot her se ri es, the oc cur ren ce of mu co sal le si ons was not avo i ded but co uld me rely be de la yed. 33 In this study, en dos co pic prog res si on was 69% whe reas fo ur out of 56 pa ti ents sho wed cli ni cal re cur ren ce at the end of fi ve ye ars.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Azathioprine Therapy in Turkish Patients with Inflammatory Bowel Disease: A Retrospective Long Term Follow Up Study

Önal¹,

Arhan²,

Özın³

et al. 2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : Ef fec ti vity and sa fety of azat hi op ri ne in the tre at ment of inf lam ma tory bowel di se a se ha ve be en pro ved and ci ted in many ar tic les. Ob jec ti ve of this study is to eva lu a te the effi cacy and si de ef fects of azat hi op ri ne par ti cu larly in the long term tre at ment and post sur gi cal proph yla xis of Crohn's di se a se in Tur kish pa ti ents with inf lam ma tory bo wel di se a se. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : Pa ti ents tre a ted with azat hi op ri ne we re en rol led in this study and the ef ficacy of azat hiop ri ne was as ses sed with Tru e lo ve-Witts and Crohn's Di se a se Ac ti vity In de xes, retrospectively. R Re e --s su ul lt ts s: : A total of 122 pa ti ents tre a ted with azat hi op ri ne with a me di an du ra ti on of 24 months, inc lu ding 109 pa ti ents with Crohn's di se a se and 13 with ul ce ra ti ve co li tis, we re eva lu a ted. Res ponse (comp le te or par ti al re mis si on) was ob ser ved in 106 (98+8, 87%) of 122 pa ti ents. The me di an dura ti on of re mis si on du ring the tre at ment was 21 months. Ad ver se ef fects we re ob ser ved in 16% (19/122) of our pa ti ents and mye lo to xi city was the most fre qu ent ad ver se ef fect seen in 6.6% (8/122) of the patients. Drug dis con ti nu a ti on ra te du e to si de ef fects was 9.8%. Ove rall res pon se (comp le te and par ti al re mis si on)was seen in 38 (36+2, 90.5%) out of 42 pa ti ents that had be en ta king azat hi oprin for mo re than fo ur ye ars with a me di an period of 60 months. The me di an of re mis si on du ra ti on in tho se pa ti ents that had si mi lar si de ef fects was 53 months. Cli ni cal re cur ren ce was se en in six of 31 pa ti ents tre a ted with azat hi op ri ne for post-sur gi cal proph yla xis in a me di an fol low-up of 42 months. C Co on nc c l lu u s si i o on n: : Our study re-af fir med the sa fety and the ef fec ti ve ness of azat hi op ri ne in the treat ment of inf lam ma tory bo wel di se a se, es pe ci ally for post-sur gi cal proph yla xis and the long term tre at ment. K Ke ey y W Wo or rd ds s: : Inf lam ma tory bo wel di se a ses; azat hi op ri ne; ad ver se ef fects Ö ÖZ ZE ET T A Am ma aç ç: : Azatioprinin inf la ma tu ar bağırsak has ta lı ğı (İBH) nın te da vi sin de ki et kin li ği ve gü -ve ni lir li li ği hak kın da der len miş ka nıt lar bu lun mak ta dır. Ça lış ma mı zın ama cı, İBH olan Türk hasta lar da özel lik le de Crohn's has ta lı ğı nın uzun dö nem te da vi si ve cer ra hi son ra sı pro fi lak si si üze ri ne vur gu yap mak üze re ila cın et kin li ği ve yan et ki du ru mu nu or ta ya koy mak tır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Azatioprin te da vi si al mış top lam 122 has ta ge ri ye dö nük de ğer len di ril mek üze re ça -lış ma ya alın mış tır. İla cın et kin li ği ni be lir le me de Tru e lo ve-Witts ve Crohn Has ta lı ğı Ak ti vi te İn-deks le ri kul la nıl mış tır. B Bu ul l g gu u l la ar r: : Top lam 109 Crohn ve 13 ül ...

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“…Immunomodulators have been shown to be efficient for the control of inflammation and remission maintenance. Only limited data exists on the efficacy of immunosuppressants in fistulizing Crohn's disease and the prevention of postoperative recurrence [24][25][26][27][28][29][30] . Evidence-based data is missing on the post-operative use of azathioprine and many IBD referral centers are using azathioprine for the prevention of post-operative recurrence.…”

Section: Immunosuppressivesmentioning

confidence: 99%

Practical guidelines for the treatment of inflammatory bowel disease

Kühbacher¹

2007

WJG

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Postoperative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine, or placebo: A 2-year trial

Cited by 427 publications

References 27 publications

Management of Crohn's Disease in Adults

Management of Crohn's Disease in Adults

Efficacy and Safety of Azathioprine Therapy in Turkish Patients with Inflammatory Bowel Disease: A Retrospective Long Term Follow Up Study

Practical guidelines for the treatment of inflammatory bowel disease

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