P400 Risk-adjusted use of thiopurines prevented surgical recurrence in patients with Crohn's disease after intestinal resection

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Background: Thiopurines (TPs) are effective in reducing risk of clinical and endoscopic recurrence in postoperative patients with Crohn's disease (CD). However, whether TPs could prevent surgical recurrence (need for re-resection) remains to be clarified. Our aim was to explore risk factors associated with surgical recurrence (SR) in CD patients after intestinal surgery.

Methods: This was a retrospective cohort study of 246 patients who underwent surgery for CD in a tertiary referral center. Cox proportional hazard model was used to identify independent risk factors associated with SR. Patients were stratified according to the presence of risk factors, and the impact of TPs use on preventing SR in patients with different risk-profile was evaluated.

Results: A total of 50 (20.3%) out of 246 operated patients suffered SR after a median of 54.3±46.4 months. Multivariate analysis showed three risk factors independently associated with SR: penetrating disease behavior (hazard ratio (HR) 8.628; 95% confidence interval (CI) 1.573–47.341; p=0.013), ileocolonic disease location (HR 2.597; 95% CI 1.047–6.445; p=0.040) and isolated upper gastrointestinal (GI) disease location (HR 5.082; 95% CI 1.496–17.267; p=0.009). However, use of TPs after surgery significantly reduced the risk of SR (HR 0.120; 95% CI 0.063–0.231; p=0.000). When stratifying patients into low risk (none of three risk factors) and high risk group (≥one risk factor), there were no statistical difference of SR between patients treated or not by TPs (HR 0.196; 95% CI 0.032–1.190; p=0.077) in low risk group (n=46). However, among patients at high risk (n=200), the patients with TPs use had a lower risk of SR than those without TPs (HR 0.093; 95% CI 0.048–0.178; p=0.000).

Conclusions: Penetrating disease behavior and ileocolonic/isolated upper GI disease are associated with SR in CD patients. TPs use is beneficial in decreasing risk for SR in CD patients at high risk. Large cohorts of low-risk patients are needed to determine the value of TPs in this population.

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