| Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn's disease: a meta-analysis. | |
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MedLine Citation:
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PMID: 19568226 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Meta-Analysis; Review Date: 2009-06-30 |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 104 ISSN: 1572-0241 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-08-07 Completed Date: 2009-08-20 Revised Date: 2011-01-28 |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 2089-96 Citation Subset: IM |
Affiliation:
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Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille 59037, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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6-Mercaptopurine
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therapeutic use* Azathioprine / therapeutic use* Crohn Disease / prevention & control*, surgery* Humans Immunosuppressive Agents / therapeutic use* Recurrence |
| Chemical | |
Reg. No./Substance:
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0/Immunosuppressive Agents; 446-86-6/Azathioprine; 50-44-2/6-Mercaptopurine |
| Comments/Corrections | |
Comment In:
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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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