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|Title:||Efficacy of thiopurines and adalimumab in preventing Crohn's disease recurrence in high-risk patients - a POCER study analysis|
|Author:||De Cruz, P.|
|Citation:||Alimentary Pharmacology and Therapeutics, 2015; 42(7):867-879|
|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|
|Appears in Collections:||Medicine publications|
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