Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn’s disease patients
Gláucio Silva de Souza, Fernando Mendonça Vidigal, Liliana Andrade Chebli, Tarsila Campanha da Rocha Ribeiro, Maria Cristina Vasconcellos Furtado, Fábio Heleno de Lima Pace, Leonardo Duque de Miranda Chaves, Karine Andrade de Oliveira Zanini, Pedro Duarte Gaburri, Fernando de Azevedo Lucca, Alexandre Zanini, Luiz Cláudio Ribeiro, Julio Maria Fonseca Chebli
Juiz de Fora, Brazil
Med Sci Monit 2013; 19:716-722
Although the cost of Crohn’s disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs.
Material and Methods: We evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2–3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups.
Results: On an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients.
Conclusions: Patients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.
Keywords: Crohn Disease - surgery, Azathioprine - therapeutic use, Adult, Incidence, Kaplan-Meier Estimate, Mesalamine - therapeutic use, Patient Readmission - statistics & numerical data