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P152. Influence of treatment with azathioprine on the risk of surgery in patients with Crohn's disease

E. Leo Carnerero, C. Trigo Salado, D. De La Cruz Ramirez, A. Araujo Miguez, J.M. Herrera Justiniano, J.L. Marquez Galan

Hospital Virgen Del Rocio, Sevilla, Spain

Objective: To determine whether the use of azathioprine (AZA) in patients with Crohn's Disease (CD) decreases surgical risk – intestinal resection – over the long term.

Patients and methods: Retrospective study including 116 patients with CD with at least 1 year of evolution, after excluding patients with surgery in the first 4 months after diagnosis. Patients are considered not to have been treated with AZA (no AZA, n 57) when treatment was never carried out, was received for a short time due to side effects or surgery or were treated for the first time after surgery (post-surgical prophylaxis). The other 59 patients had been treated with AZA.

In each group we analyzed the age at diagnosis and time of evolution of the CD, tobacco habit, phenotype of the CD, need for surgery and biological treatment.

Results: We did not find differences in the age at diagnosis of the CD (AZA 27.4 years vs. no AZA 30.8), smoking (52.5% vs. 54.4%), ileal involvement (78% vs. 78.9%) and stenosing/penetrating behaviour patterns (37.3 vs. 50.9%; p 0.1).

Among the patients taking AZA, surgical risk is lower (15.3 vs. 42.1%; p = 0.003) and although the time of evolution of the CD is lower (79 vs. 117 months, p = 0.01) the multivariate analysis shows that treatment with AZA is an independent protective factor against surgery. In fact, at 5 years of evolution of CD, 4.1% of the 24 patients who took AZA had required surgery, compared with 22.4% of those that had not (p = 0.04). Biological therapy is also higher among patients in the AZA group (33.9 vs. 14%), but when patients treated with anti-TNF are excluded, risk of surgery continues to be higher in the non-AZA group (32.7 vs. 12.8%; p < 0.05).

Conclusions: The use of azathioprine in CD is associated with better evolution with lower risk of surgery, independent of the existence of other factors predicting poor evolution. We do not have data to determine whether the time of initiating treatment is determinant.