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Type: Journal article
Title: Efficacy of thiopurines and adalimumab in preventing Crohn's disease recurrence in high-risk patients - a POCER study analysis
Author: De Cruz, P.
Kamm, M.
Hamilton, A.
Ritchie, K.
Krejany, E.
Gorelik, A.
Liew, D.
Prideaux, L.
Lawrance, I.
Andrews, J.
Bampton, P.
Jakobovits, S.
Florin, T.
Gibson, P.
Debinski, H.
Gearry, R.
Macrae, F.
Leong, R.
Kronborg, I.
Radford-Smith, G.
et al.
Citation: Alimentary Pharmacology and Therapeutics, 2015; 42(7):867-879
Publisher: Wiley
Issue Date: 2015
ISSN: 0269-2813
Statement of
P. De Cruz ... J. M. Andrews ... et al.
Abstract: Background: Crohn's disease recurs in the majority of patients after intestinal resection. Aim: To compare the relative efficacy of thiopurines and anti-TNF therapy in patients at high risk of disease recurrence. Methods: As part of a larger study comparing post-operative management strategies, patients at high risk of recurrence (smoker, perforating disease, ≥2nd operation) were treated after resection of all macroscopic disease with 3 months metronidazole together with either azathioprine 2 mg/kg/day or mercaptopurine 1.5 mg/kg/day. Thiopurine-intolerant patients received adalimumab induction then 40 mg fortnightly. Patients underwent colonoscopy at 6 months with endoscopic recurrence assessed blind to treatment. Results: A total of 101 patients [50% male; median (IQR) age 36 (25–46) years] were included. There were no differences in disease history between thiopurine- and adalimumab-treated patients. Fifteen patients withdrew prior to 6 months, five due to symptom recurrence (of whom four were colonoscoped). Endoscopic recurrence (Rutgeerts score i2–i4) occurred in 33 of 73 (45%) thiopurine vs. 6 of 28 (21%) adalimumab-treated patients [intention-to-treat (ITT); P = 0.028] or 24 of 62 (39%) vs. 3 of 24 (13%) respectively [per-protocol analysis (PPA); P = 0.020]. Complete mucosal endoscopic normality (Rutgeerts i0) occurred in 17/73 (23%) vs. 15/28 (54%) (ITT; P = 0.003) and in 27% vs. 63% (PPA; P = 0.002). The most advanced disease (Rutgeerts i3 and i4) occurred in 8% vs. 4% (thiopurine vs. adalimumab). Conclusions: In Crohn's disease patients at high risk of post-operative recurrence adalimumab is superior to thiopurines in preventing early disease recurrence.
Keywords: Humans; Crohn Disease; Recurrence; Metronidazole; 6-Mercaptopurine; Azathioprine; Tumor Necrosis Factor-alpha; Colonoscopy; Treatment Outcome; Drug Therapy, Combination; Postoperative Period; Risk Factors; Follow-Up Studies; Adult; Aged; Middle Aged; Female; Male; Adalimumab
Rights: © 2015 John Wiley & Sons Ltd
RMID: 0030059835
DOI: 10.1111/apt.13353
Appears in Collections:Medicine publications

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