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

Abstract

Background: Recurrence of Crohn's disease alter 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). Logrank 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.