Prolonged azathioprine treatment reduces the need for surgery in early Crohn's disease

Qiu, Yun; Chen, Baili; Feng, Rui; Zhang, Shenghong; He, Yao; Zeng, Zhirong; Ben‐Horin, Shomron; Peyrin–Biroulet, Laurent; Mao, Ren; Chen, Minhu

doi:10.1111/jgh.14000

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…[21][22][23] In this study, previous different previous intestinal surgery rates did not seem to affect baseline LI, whereas intestinal reception was one of the most decisive and scoring items in LI. During the follow-up period, the CD-related bowel resection rate was 14.3%, which was similar to certain previous studies, 24,25 but lower than that in other studies. 26,27 Patients with longer disease duration tended to have a higher intestinal surgery rate than patients with early CD (20.2% vs. 7.1%, P = 0.001).…”

Section: Discussionsupporting

confidence: 89%

Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index

Zhu

Feng

et al. 2020

Preprint

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Background: Clinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors. Methods: We analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups. Results: We included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery. Conclusions: Early intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann Index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.

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Section: Discussionsupporting

confidence: 89%

Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index

Zhu

Feng

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In this study, previous different previous intestinal surgery rates did not seem to affect baseline LI, whereas intestinal reception was one of the most decisive and scoring items in LI. During the follow-up period, the CD-related bowel resection rate was 14.3%, which was similar to certain previous studies, [ 24 , 25 ] but lower than that in other studies [ 26 , 27 ]. Patients with longer disease duration tended to have a higher intestinal surgery rate than patients with early CD (20.2% vs. 7.1%, P = 0.001).…”

Section: Discussionsupporting

confidence: 89%

Efficacy of early intervention on the bowel damage and intestinal surgery of Crohn’s disease, based on the Lémann index

Zhu

Feng

et al. 2020

BMC Gastroenterol

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Background Clinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors. Methods We analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups. Results We included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery. Conclusions Early intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.

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“…Even though some observational studies showed no benefits, [ 4 , 19 , 37 , 39 , 42 ] 1 meta-analysis [ 5 ] and other observational studies did show benefit of early use in reducing CD-related surgeries. [ 11 , 17 , 18 , 20 , 23 , 32 , 34 , 38 , 40 , 43 ] In this cohort, we performed subgroup analysis to determine this effect. To ensure the benefits of thiopurines, only those who took the medicine for at least 3 months were included.…”

Section: Discussionmentioning

confidence: 99%

Temporal trend of disease recognition, treatment paradigm, and clinical outcomes of Crohn disease in Thailand from 2000 through 2017

et al. 2020

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Prolonged azathioprine treatment reduces the need for surgery in early Crohn's disease

Abstract: Prior bowel resection, smoking, and hemoglobin < 110 g/L at the time of initiation of AZA were risk factors associated with intestinal surgery in patients with early CD. However, prolonged use (≥ 36 months) of AZA was associated with a more favorable disease course of early CD.

Cited by 9 publications

References 36 publications

Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index

Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index

Efficacy of early intervention on the bowel damage and intestinal surgery of Crohn’s disease, based on the Lémann index

Temporal trend of disease recognition, treatment paradigm, and clinical outcomes of Crohn disease in Thailand from 2000 through 2017

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