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https://hdl.handle.net/2440/103788
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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.A. Hamilton, A.L. Ritchie, K.J. Krejany, E.O. Gorelik, A. Liew, D. Prideaux, L. Lawrance, I.C. Andrews, J.M. Bampton, P.A. Jakobovits, S. Florin, T.H. Gibson, P.R. Debinski, H. Gearry, R.B. Macrae, F.A. Leong, R.W. 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 1365-2036 |
Statement of Responsibility: | 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 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 Mercaptopurine |
Rights: | © 2015 John Wiley & Sons Ltd |
DOI: | 10.1111/apt.13353 |
Grant ID: | NHMRC |
Published version: | http://dx.doi.org/10.1111/apt.13353 |
Appears in Collections: | Aurora harvest 7 Medicine publications |
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