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DOP043. The role of thiopurines in reducing the need for first intestinal resection in Crohn's disease: A systematic review and meta-analysis

S. Chatu1, V. Subramanian2, S. Saxena3, R. Pollok1, 1St Georges University Hospital, Gastroenterology, London, United Kingdom, 2St Jame's University Hospital, Center for Digestive Diseases, Leeds, United Kingdom, 3Imperial College London, Primary care and Public Health, London, United Kingdom

Background

The thiopurine (TP) analogues azathioprine and mercaptopurine have proven efficacy in inducing and maintaining clinical remission in Crohn's disease (CD). Their impact on the long term need for surgery is uncertain since studies have reported conflicting results. The aim of this systematic review was to summarize and evaluate evidence of the published literature regarding those studies assessing the impact of TPs on the risk of first surgical resection in CD.

Methods

We searched Medline, EMBASE, CINAHL, and hand searched reference lists of identified articles, without language restrictions in August 2013.

Results

Seventeen retrospective observational studies (Eight population based, three multicenter and Six referral center) representing 21, 632 participants met our inclusion criteria. Of these ten studies involving 12, 586 participants provided data on the hazard ratio and 95% confidence intervals evaluating use of TPs and surgical risk. The combined pooled hazard ratio of first intestinal resection with thiopurine use was 0.59 (95% CI 0.48–0.73) (Figure 1).

Figure 1. Forest plot of studies reporting hazard ratio associated with thiopurine use and risk of surgery in CD patients.

Conclusion

TP use is associated with a 40% lowered risk of surgical resection in patients with CD. Despite significant reductions in rates of surgical resection in patients with CD over the last 5 decades and increasing use of TPs a large proportion of patients with CD still require resectional surgery.