Azathioprine as a postoperative prophylaxis reduces symptoms in aggressive Crohn's disease

Scand J Gastroenterol. 2006 Oct;41(10):1190-5. doi: 10.1080/00365520600587378.


Objective: Recurrence of Crohn's disease (CD) after surgery is common. Azathioprine/6-mercaptopurine (Aza/6-MP) is effective in controlling medically induced remission but, so far, has only been sparsely investigated after surgically induced remission. This study comprises a subset of CD patients considered to have an aggressive disease course and chosen for treatment with Aza postoperatively.

Material and methods: In 1989-2000, a total of 100 patients with CD were given Aza/6-MP as a postoperative prophylaxis. Fourteen Aza/6-MP-intolerant patients were compared with 28 Aza-tolerant patients, matched for gender, age, and duration of disease. Patients were prospectively registered for symptoms using a modified Crohn's disease activity index (CDAI) and perceived health was assessed on a visual analogue scale (VAS). The primary outcome variable was the modified CDAI postoperatively integrated over time; other variables were time to first relapse (modified CDAI >or= 150), time to first repeated surgery, number of courses of steroids, and repeated surgery per year of follow-up. Patients were followed for a median of 84.7 months (23.2-140).

Results: The modified CDAI integrated over time was 93 for Aza-treated patients compared with 184 for controls (p=0.01) and time to first relapse was 53 and 24 months, respectively (p<0.05). Aza-treated patients needed fewer courses of corticosteroids (p=0.05) compared with controls. Perceived health did not differ between the groups, nor did need of repeated surgery. Time to first repeat operation was 53 and 37 months, respectively.

Conclusions: In CD patients considered to have an aggressive disease course, Aza reduced symptoms after surgery and prolonged the time to symptomatic relapse. The findings support a role for Aza as a postoperative maintenance treatment in CD.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Azathioprine / administration & dosage
  • Azathioprine / therapeutic use*
  • Crohn Disease / drug therapy*
  • Crohn Disease / physiopathology*
  • Crohn Disease / surgery
  • Female
  • Humans
  • Male
  • Mercaptopurine / administration & dosage
  • Middle Aged
  • Postoperative Period
  • Recurrence
  • Reoperation


  • Mercaptopurine
  • Azathioprine