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P213. Use of azathioprine during pregnancy and in the postoperative setting in Crohn's disease: A worldwide survey of experts

L. Peyrin-Biroulet1, A. Oussalah1, X. Roblin2, M. Sparrow3

1University Hospital of Nancy, Vandoeuvre-lès-Nancy, France; 2University Hospital of Saint-Etienne, Saint-Etienne, France; 3The Alfred Hospital, Melbourne, Australia

Aims: While thiopurines are considered safe in human, they are still pregnancy FDA category D drugs. Data on the clinical use of azathioprine (AZA) during pregnancy in inflammatory bowel disease (IBD) are scarce. Prevention of postoperative recurrence is a challenge in clinical practice in Crohn's disease. The ECCO consensus stated that thiopurine should be considered in high-risk patients. The use of thiopurine in daily practice to prevent postoperative recurrence in Crohn's disease is unknown.

Materials and Methods: This was a Web-based Cross-sectional survey consisting of 30 multiple-choice and open-ended questions, which was conducted among experts who have published at least once in the field.

Results: Between December 20, 2009 and April 9, 2010, 175 questionnaires were received. The median number of IBD patients per physician per year was 400 (IQR 25–75th, 188–600) and the total number of IBD patients followed by all responders was 82,379. In a pregnant woman with a history of severe Crohn's disease in clinical remission since 1 year on AZA, 88.6% of experts usually continue AZA until delivery and 9.1% of physicians never administrate AZA during pregnancy. After ileocecal resection for Crohn's disease, 39.4% of physicians initiate AZA only in high-risk patients, 28% of practitioners prescribe AZA according to endoscopic evaluation, 20% of gastroenterologists systematically initiate AZA, and 12.6% have a different attitude.

Conclusion: Almost 9 out of 10 physicians continue AZA throughout pregnancy. About 7 out of 10 physicians prescribe AZA in the postoperative setting according to ECCO recommendations, whereas one-fifth of practitioners systematically initiate AZA after surgery.