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Introduction of 6-mercaptopurine in Crohn's disease patients during the perioperative period: a preliminary evaluation of recurrence of disease.

AbstractBACKGROUND:
Recurrence of Crohn's disease after surgery is a common occurrence, pointing to the need for a strategy to prevent recurrent disease. We report the postoperative course of 10 patients who required intestinal resections for complications related to Crohn's disease.
METHODS:
All patients had a Pediatric Crohn's Disease Activity Index score of 10 or greater. Among these patients, 5 began treatment with 6-mercaptopurine in the perioperative period. All 10 had received various combinations of prednisone and salicylate compounds. Patients who were given 6-mercaptopurine did not discontinue the medication until 2 years after the surgery.
RESULTS:
To date, none of the five patients who were placed on 6-mercaptopurine have had recurrence of their Crohn's disease (mean disease-free period 32.6 +/- 18.4 months). Among those five patients not receiving 6-mercaptopurine there have been three relapses (mean time to relapse 3.7 +/- 1.2 months). Log-rank sum analyses of Kaplan-Meier survival curves show benefit to patients receiving 6-mercaptopurine in preventing relapses after intestinal resection (p < 0.05).
CONCLUSIONS:
Although the underlying pathophysiologic reasons leading to the high relapse rate after intestinal surgery in Crohn's disease are unknown, we conclude that treatment with 6-mercaptopurine in the perioperative period may be warranted to help prevent the recurrence of Crohn's disease after surgery.
AuthorsH A Kader, S C Raynor, R Young, S S Kaufman, J Vanderhoof, E I Ruby, D R Mack
JournalJournal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 25 Issue 1 Pg. 93-7 (Jul 1997) ISSN: 0277-2116 [Print] United States
PMID9226535 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Antimetabolites, Antineoplastic
  • Mercaptopurine
Topics
  • Adolescent
  • Adult
  • Antimetabolites, Antineoplastic (therapeutic use)
  • Child
  • Crohn Disease (physiopathology, prevention & control, surgery)
  • Follow-Up Studies
  • Humans
  • Intestines (surgery)
  • Mercaptopurine (therapeutic use)
  • Postoperative Period
  • Recurrence
  • Survival Analysis
  • Time Factors

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