Nutritional therapy versus 6-mercaptopurine as maintenance therapy in patients with Crohn's disease.

Abstract

BACKGROUND:

6-Mercaptopurine is often used as maintenance therapy in patients with Crohn's disease. However, toxicities like myelosuppression limit its clinical benefit.

AIMS:

To evaluate the efficacy of elemental diet versus 6-mercaptopurine as maintenance therapy in Crohn's disease.

METHODS:

Ninety-five eligible patients with Crohn's disease activity index ≤150 were randomly assigned to: 6-mercaptopurine (0.5-1.5mg/kg/day, n=30); Elental as an elemental diet (≥900 kcal/day, n=32); none (control, n=33). In the three groups, patients were and remained on 5-aminosalicylic acid (2250-3000 mg/day). Patients were observed for 2 years and the rate of relapse (Crohn's disease activity index ≥200) was monitored.

RESULTS:

At 24 months, the fractions of patients who had maintained remission were 60%, 46.9% and 27.2% for 6-mercaptopurine, Elental and the control groups, respectively. Log-rank test showed better efficacy for 6-mercaptopurine (P=0.0041) and Elental (P=0.0348) versus control. No significant difference was found between 6-mercaptopurine and Elental. Further, in the 6-mercaptopurine group, 2 patients experienced liver injury and one developed alopecia.

CONCLUSIONS:

This 24 months comparison study showed that Elental as maintenance therapy in Crohn's disease patients was as effective as 6-mercaptopurine. Elental should be useful for long-term maintenance therapy in Crohn's disease. This is the first comparison study evaluating nutritional therapy versus 6-mercaptopurine.

• Authors: Hiroyuki Hanai, Takayuki Iida, Ken Takeuchi, Hajime Arai, Osamu Arai, Jinrou Abe, Tatsuo Tanaka, Yasuhiko Maruyama, Kentarou Ikeya, Ken Sugimoto, Toshio Nakamura, Kouichi Nakamura, Fumitoshi Watanabe
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 44 Issue 8 Pg. 649-54 (Aug 2012) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 22542605 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Immunosuppressive Agents
• Mesalamine
• Mercaptopurine

Topics

• Adult
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Crohn Disease (diet therapy, drug therapy)
• Food, Formulated (adverse effects)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kaplan-Meier Estimate
• Longitudinal Studies
• Maintenance Chemotherapy
• Male
• Mercaptopurine (adverse effects, therapeutic use)
• Mesalamine (therapeutic use)
• Recurrence
• Young Adult