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Julia J. Liu, Purine analog for the prevention of postoperative recurrence of Crohn's disease: Is it really better?, Inflammatory Bowel Diseases, Volume 17, Issue 2, 1 February 2011, Pages 665–666, https://doi.org/10.1002/ibd.21340
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Peyrin-Biroulet L, Deltenre P, Ardizzone S, et al. Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn's disease: a meta-analysis. Am J Gastroenterol. 2009;104:2089-2096.
Postoperative recurrence of Crohn's disease (CD) is a major clinical problem for gastroenterologists and their patients. Endoscopic recurrence, which precedes clinical recurrence, has been reported in up to 90% of patients undergoing resection.1,2 To prevent recurrence, patients are routinely placed on antibiotic therapy (metronidazole for 3 months) with or without 5-aminosalicylate compounds. Studies examining the efficacy of purine analogs compared to conventional therapy have yielded conflicting results.3,4
Peyrin-Biroulet et al performed a meta-analysis of randomized controlled trials to define the effect of purine analogs (azathioprine or 6-mercaptopurine) for the prevention of postoperative CD. The control group consisted of placebo or mesalamine. Since only studies reporting the clinical and endoscopic recurrence were included in this meta-analysis, 11 out of 15 potentially eligible articles were excluded. There were a total of 433 patients from four clinical trials: 198 patients were treated with purine analogs and 235 patients received controls. For clinical recurrence rate at 1 year, the mean difference between the two groups was 8% (95% confidence interval [CI]: 1%-15%) with a number needed to treat (NNT) of 13; at 2 years, the mean difference between the two groups was 13% (95% CI: 2%-24%) with an NNT of 8. For endoscopic recurrence, three studies involving 293 patients with endoscopic evaluations performed at 1 year were included in the analysis. There were 129 patients in the purine analogs group and 164 in the control arms. At 1 year the mean difference in recurrence rate between the two groups was 15% (95% CI: 1.8%-29%) with an NNT of 7. The efficacy at 2 years was not evaluated since only one study was available for this endpoint.
