Efficacy of thiopurines and adalimumab in preventing Crohn's disease recurrence in high‐risk patients – a POCER study analysis. Issue 7 (28th August 2015)

• Record Type: Journal Article
• Authors: 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.; Selby, W.; Johnston, M. J.; Woods, R.; Elliott, P. R.; Bell, S. J.; Brown, S. J.; Connell, W. R.; Desmond, P. V.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 42:Issue 7(2015)
• Page Start: 867
• Page End: 879
• Publication Date: 2015-08-28
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13353
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13353-abs-0001"> <title>Summary</title> <sec id="apt13353-sec-0001" sec-type="section"> <title>Background</title> <p>Crohn's disease recurs in the majority of patients after intestinal resection.</p> </sec> <sec id="apt13353-sec-0002" sec-type="section"> <title>Aim</title> <p>To compare the relative efficacy of thiopurines and anti‐TNF therapy in patients at high risk of disease recurrence.</p> </sec> <sec id="apt13353-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="apt13353-sec-0004" sec-type="section"> <title>Results</title> <p>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); <italic>P </italic>=<italic> </italic>0.028] or 24 of 62 (39%) vs. 3 of 24 (13%) respectively [per‐protocol analysis (PPA); <italic>P </italic>=<italic> </italic>0.020]. Complete mucosal endoscopic normality (Rutgeerts i0) occurred in 17/73 (23%) vs. 15/28 (54%) (ITT; <italic>P </italic>=<italic> </italic>0.003) and in 27% vs. 63% (PPA; <italic>P </italic>=<italic> </italic>0.002). The most advanced disease (Rutgeerts i3 and i4) occurred in 8% vs. 4% (thiopurine vs. adalimumab).</p> </sec> <sec id="apt13353-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In Crohn's disease patients at high risk of post‐operative recurrence adalimumab is superior to thiopurines in preventing early disease recurrence.</p> </sec> </abstract>