Is There Still a Role for Thiopurines in Crohn's Disease?

Early Use of Thiopurines or Methotrexate Reduces Major Abdominal and Perianal Surgery in Crohnʼs Disease

“…Anti-TNF treatments were given on an episodic basis and reserved for complicated and severe disease late in the disease course. 33 There are a few limitations of this study. 30 Even with scheduled maintenance biological agents, they may be associated with high cost, risk of severe adverse reactions including life-threatening infections, primary nonresponse in one-third of patients and progressive secondary loss of response.…”

“…The study population was an ambulatory nonhospital-based specialistreferred cohort, based within the Sydney Local Health District rather from national databases. 33 Data to demonstrate absolute improved outcomes, however, are also needed to support their use given their known risk of adverse events. Similar strategies have been employed in other Australian and New Zealand population-based cohort.…”

Editorial: weighing the global risk of cancer with thiopurines in inflammatory bowel disease

“…1,2 As they mentioned, IBD is characterised by chronic recurrent intesti- and we had discussed the differences between our study and Jess's in our meta-analysis. 2 Thiopurines have been reported to exhibit the potential to induce or propagate some malignancies (eg lymphoma, nonmelanoma skin cancers, cervical cancer and pancreatic cancer), 4-8 while these serious events of thiopurines have not always been supported by other studies. One meta-analysis performed by Shelton et al showed that immunomodulator therapy does not increase the recurrent cancer risk in individuals with prior cancer compared to those who did not receive immunosuppressors.…”

“…The authors' declarations of personal and financial interests are unchanged from those in the original article. 2 O R C I D X. Y. Qiu http://orcid.org/0000-0001-6409-2408…”

Medical Therapy for Crohn’s Disease: The Present

“…A similar double blind prospective study of azathioprine versus placebo within 8 weeks of disease diagnosis (only other medication allowed was corticosteroids) showed no difference in corticosteroid free remission at 76 weeks, although azathioprine did reduce the rate of moderate-severe relapse [ 39 ]. These studies suggest there is limited benefi t to monotherapy with thiopurines early in the course of disease, for the endpoint of steroid-free remission [ 40 ]. Long-term cohort studies have shown that early azathioprine use within 3 years of initial diagnosis was associated with a reduced risk of initial abdominal surgery (HR 0.45), recurrent abdominal surgery (HR 0.44), and perianal surgery (HR 0.30) [ 41 ].…”