Prevention of postoperative recurrence of Crohn’s disease: Tripterygium wilfordii polyglycoside versus mesalazine

Abstract

Objectives: To explore effectiveness and safety of polyglycosides of Tripterygium wilfordii (GTW) and mesalazine (5-aminosalicylic acid [5-ASA]) in preventing postoperative clinical and endoscopic recurrence of Crohn's disease. Methods: In this prospective, single-centre, single-blind study, postoperative Crohn's disease patients in remission were randomized to receive 1 mg/kg GTW daily, orally, or 4 g 5-ASA daily, orally, for 52 weeks. Patients underwent physical examinations, ileocolonoscopies and biochemical analyses at baseline and weeks 13, 26 and 52, or when clinical recurrence was suspected. Outcome measures were proportion of patients showing clinical or endoscopic recurrence at week 52, and changes in Rutgeerts' and Crohn's Disease Activity Index (CDAI) scores. Results: Twenty-one patients were assigned to receive GTW and 18 to 5-ASA; two patients on GTW and one on 5-ASA were withdrawn. Clinical and endoscopic recurrences were less common in the GTW group (n ¼ 4) versus the 5-ASA group (n ¼ 9). There were improvements in Rutgeerts' scores for those taking GTW. Mean between-group CDAI scores were similar. No serious adverse events were reported. Conclusion: These findings indicate that GTW appears to be an effective, well-tolerated prophylactic regimen, superior to oral 5-ASA, for preventing clinical and endoscopic recurrence in postsurgical Crohn's disease.

Comparative Efficacy of Pharmacologic Interventions in Preventing Relapse of Crohn’s Disease After Surgery: A Systematic Review and Network Meta-analysis

“…7, 8, 21–39 Six RCTs of 5-ASA therapy were excluded (because of unclear timing of initiation of post-operative prophylaxis or initiation beyond 3 months of surgery, 40–42 comparison of different dosing regimens of 5-ASA without a common comparator group, 43 short duration of study (3-month outcome assessment), 44 and comparison with a therapy of unproven benefit (parasite therapy). 45 One RCT comparing 5-ASA (and probiotics) to rifaximin was also excluded due to unclear timing of initiation of post-operative prophylaxis. 46 One RCT comparing azathioprine to 5-ASA for prevention of clinical relapse after established endoscopic relapse was also excluded.…”

Celastrol: A Spectrum of Treatment Opportunities in Chronic Diseases

“…In addition, two placebo-controlled trials and one prospective single-blind clinical trial have studied the therapeutic potential of polyglycoside TW (1 mg/kg daily) in the prevention of postsurgical relapses in patients with CD. Results from these studies suggest that this is an effective and well-tolerated drug (3–5). Recently, a randomized clinical trial has shown that TW (1.5 mg/kg/day) was comparable to azathioprine to prevent postoperative clinical recurrence of CD, although less efficient in preserving endoscopic remission at week 52 (6).…”

Strategies for Preventing Endoscopic Recurrence of Crohn’s Disease 1 Year after Surgery: A Network Meta-Analysis

“…f. [5, 11], Lactobacillus GG [15], and untreated intervention [7], alone or combination therapies preventing CD recurrence after surgery, based on direct and indirect evidence from RCTs.…”