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P122. The natural history of Crohn's disease: Impact of the introduction of thiopurines on its outcome

F. Casals-Seoane1, J.P. Gisbert1, M. Chaparro1

1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain

Background: The efficacy of thiopurines in Crohn's disease has been shown in clinical trials and their use has increased over the past decades. However, it is unclear whether early and widespread use of these drugs may reduce surgical requirements in routine practice, or may change the long-term outcome of Crohn's disease.

Aims: To assess the impact of thiopurine treatment on the outcome of Crohn's disease.

Methods: A retrospective study including Crohn's disease patients was performed. Patients who had received thiopurines at appropriate doses (azathioprine 2.5 mg/kg and mercaptopurine 1.5 mg/kg) were reviewed. Data from flares, hospitalizations, surgeries, corticosteroid use and complications during the 12 months before and after the introduction of thiopurines were compared. Patients with incomplete data in their medical records were excluded.

Results: Seventy-eight patients with Crohn's disease who had received thiopurine treatment were included. Mean time of evolution was 16 years (range 8–41 years). Thiopurine treatment reduced the number of flares (1.15 vs 0.28, p < 0.001), hospitalizations (1.05 vs 0.34, p < 0.001), corticosteroid requirements (1.17 cycles vs 0.28 cycles, p < 0.001) and number of surgeries (0.76 vs 0.29, p < 0.05) (figure 1).

Figure 1. Number of events before and after thiopurine introduction.

However the rate of complications (perforation, massive bleeding, abscess or megacolon) were not significantly different before and after the introduction of thiopurines (0.6 vs 0.4, p = 0.704).

Conclusions: Thiopurine drugs improve the outcome of Crohn's disease patients by reducing the number of flares, corticosteroid requirements, hospitalizations and the need for surgery for Crohn's disease at least for the 12 months following treatment's introduction.