Azathioprine is more effective than mesalazine at preventing recurrent bowel obstruction in patients with ileocecal Crohn’s disease

Abstract

Background: Patients with subocclusive Crohn’s disease (CD) who received azathioprine (AZA) therapy had lower re-hospi-talization rates due to all causes and for surgical management of CD compared to those treated with mesala-zine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction. Material/Methods: Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-of 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 signifcantly 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.