The results of a 2 year trial of 6-mercaptopurine and mesalamine in
preventing postoperative recurrence of Crohn's disease have been
published
in this month's issue of Gastroenterology
No therapy,as yet, has been shown to reliably prevent the evolution
of
postoperative recurrence of Crohn's disease.
Daniel Present and colleagues in America compared 6-mercaptopurine
(6-MP)
and mesalamine with a placebo for the prevention of clinical,
endoscopic,
and radiographic recurrence of Crohn's disease after resection and
ileocolic
anastomosis.
In a double blind, double dummy trial, a total of 131 patients were
randomly
chosen from five different centers to receive 6-MP (50 mg),
mesalamine (3
g), or placebo daily.
Clinical assessments of patients were performed at 7 weeks and then
every 3
months; colonoscopy at 6, 12, and 24 months; and small bowel series
at 12
and 24 months.
The end points used were the clinical, endoscopic, and radiographic
recurrence rates at 24 months.
Clinical recurrence rates (intent to treat) by life-table analysis
at 24
months were 50%, 58%, and 77% in patients receiving 6-MP,
mesalamine, and
placebo, respectively.
Endoscopic recurrence rates were 43%, 63%, and 64%, and radiographic
recurrence rates were 33%, 46%, and 49%, respectively.
The researchers found that 6-MP was more effective than placebo at
preventing clinical and endoscopic recurrence over 2 years.
Patient withdrawals resulted in 69% of the study population
evaluable for
the clinical recurrence end point.
The group concluded that 6-MP, 50 mg daily, was more effective than
placebo
at preventing postoperative recurrence of Crohn's disease.
They suggested that this should be considered as a maintenance
therapy after
ileocolic resection.