Azathioprine is More Effective than Mesalazine at Preventing Recurrent Bowel Obstruction in Patients with Ileocecal Crohn’s Disease
Fernando Mendonça Vidigal, Gláucio Silva de Souza, Liliana Andrade Chebli, Tarsila Campanha da Rocha Ribeiro, Maria Cristina Vasconcellos Furtado, Antonio Carlos Santana Castro, André Luis Tavares Pinto, Bruno do Valle Pinheiro, Fabio Heleno de Lima Pace, Juliano Machado de Oliveira, Karine Andrade de Oliveira Zanini, Pedro Duarte Gaburri, Alexandre Zanini, Luiz Cláudio Ribeiro, Julio Maria Fonseca Chebli
Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil
Med Sci Monit 2014; 20:2165-2170
Patients with subocclusive Crohn’s disease (CD) who received azathioprine (AZA) therapy 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. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction.
Material and Methods: Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups.
Results: There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67–8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons).
Conclusions: In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy
Keywords: Azathioprine - therapeutic use, Adult, Crohn Disease - prevention & control, Demography, Ileocecal Valve - radiation effects, Intestinal Obstruction - prevention & control, Kaplan-Meier Estimate, Mesalamine - therapeutic use, Recurrence, Smoking - adverse effects, young adult