| The impact of thiopurines on the risk of surgical recurrence in patients with Crohn's disease after first intestinal surgery. | |
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MedLine Citation:
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PMID: 20010925 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Smoking and a lack of immunosuppressive (IS) therapy are considered risk factors for intestinal surgery in Crohn's disease (CD). Good evidence for the latter is lacking. The objective of this study was to evaluate the impact of thiopurine treatment on surgical recurrence in patients after first intestinal resection for CD and its possible interaction with smoking. METHODS: Data on 326 patients after first intestinal resection were retrieved retrospectively, and subjects were grouped according to their postoperative exposure to thiopurines. Treatment with either azathioprine (AZA) or 6-mercaptopurine (6-MP) was recorded on 161 patients (49%). Smoking status was assessed by directly contacting the patients. RESULTS: Surgical recurrence occurred in 151/326 (46.3%) patients after a median time of 71 (range 3-265) months. Cox regression revealed a significant reduction of re-operation rate in patients treated with AZA/6-MP for > or = 36 months as compared with patients treated for 3-35 months, for less than 3 months, and to those without postoperative treatment with AZA/6-MP (P=0.004). Cox regression analysis revealed treatment with thiopurines for > or = 36 months (hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.23-0.76, P=0.004) and smoking (HR 1.6; 95% CI 1.14-2.4, P=0.008) as independent predictors for surgical recurrence. Furthermore, longer duration of disease tended to be protective (HR 0.99; 95% CI 0.99-1.0, P=0.067). CONCLUSIONS: Long-term maintenance treatment with AZA/6-MP reduces the risk of surgical recurrence in patients with CD. We also identified smoking as a risk factor for surgical recurrence. |
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Authors:
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Pavol Papay; Walter Reinisch; Elien Ho; Cornelia Gratzer; Donata Lissner; Harald Herkner; Stefan Riss; Clemens Dejaco; Wolfgang Miehsler; Harald Vogelsang; Gottfried Novacek |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-12-15 |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 105 ISSN: 1572-0241 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-06 Completed Date: 2010-06-02 Revised Date: - |
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: 1158-64 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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6-Mercaptopurine
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adverse effects,
therapeutic use* Adolescent Adult Age Distribution Azathioprine / adverse effects, therapeutic use* Cohort Studies Colectomy / methods Crohn Disease / diagnosis, drug therapy*, surgery* Female Follow-Up Studies Humans Incidence Male Postoperative Care / methods Probability Proportional Hazards Models Recurrence Retrospective Studies Risk Assessment Severity of Illness Index Sex Distribution Smoking / adverse effects Statistics, Nonparametric Time Factors Treatment Outcome Young Adult |
| Chemical | |
Reg. No./Substance:
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446-86-6/Azathioprine; 50-44-2/6-Mercaptopurine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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