Document Detail


Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn's disease: a meta-analysis.
MedLine Citation:
PMID:  19568226     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To evaluate the efficacy and safety of purine analogs (azathioprine, 6-mercaptopurine (6-MP)) in the prevention of postoperative recurrence in Crohn's disease (CD).
METHODS: We searched MEDLINE, the Cochrane Library, and EMBASE. The primary end points, clinical and endoscopic recurrence at 1 and 2 years, and safety were analyzed by the methods of Peto and Der Simonian and Laird.
RESULTS: Four controlled trials enrolled 433 patients and compared azathioprine (n=3) or (6-MP) (n=1) with control arms (placebo with or without antibiotic induction therapy or mesalamine). In the overall analysis, purine analogs were more effective than control arms in preventing clinical recurrence at 1 year (mean difference, 95% confidence interval (CI): 8, 1-15%, P=0.021, number needed to treat (NNT)=13) and 2 years (mean difference, 95% CI: 13%, 2-24%, P=0.018, NNT=8). In sensitivity analyses, the efficacy of purine analogs was superior to that of placebo for the prevention of clinical and endoscopic recurrence at 1 year (mean differences, 95% CI: 13, 1.8-25%, P=0.025, NNT=7, and 23%, 9-37%, P=0.0016, NNT=4, respectively). At 1 year, in the overall analysis, purine analogs were more effective than control arms were in preventing severe (i2-4) endoscopic recurrence (mean difference, CI 95%: 15, 1.8-29%, P=0.026, NNT=7), but they were not effective in the prevention of very severe (i3-4) recurrence. The rate of adverse events leading to drug withdrawal was higher in thiopurine-treated patients than in control arms (17.2 vs. 9.8%, respectively, P=0.021).
CONCLUSIONS: Purine analogs are more effective than placebo in preventing both clinical and endoscopic postoperative recurrence in CD, but they are associated with a higher rate of adverse events leading to drug withdrawal.
Authors:
Laurent Peyrin-Biroulet; Pierre Deltenre; Sandro Ardizzone; Geert D'Haens; Stephen B Hanauer; Hans Herfarth; Marc Lémann; Jean-Frédéric Colombel
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2009-06-30
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  104     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-07     Completed Date:  2009-08-20     Revised Date:  2011-01-28    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2089-96     Citation Subset:  IM    
Affiliation:
Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille 59037, France.
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MeSH Terms
Descriptor/Qualifier:
6-Mercaptopurine / therapeutic use*
Azathioprine / therapeutic use*
Crohn Disease / prevention & control*,  surgery*
Humans
Immunosuppressive Agents / therapeutic use*
Recurrence
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 446-86-6/Azathioprine; 50-44-2/6-Mercaptopurine
Comments/Corrections
Comment In:
Inflamm Bowel Dis. 2011 Feb;17(2):665-6   [PMID:  20945458 ]
Am J Gastroenterol. 2009 Aug;104(8):2097-9   [PMID:  19661939 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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