P635 Personalised prophylactic use of thiopurines prevented surgical recurrence in patients with Crohn’s disease after intestinal resection
X. Luo, R. Mao, B. Chen, Y. He, Z. Zeng, M. Chen*
The First Affiliated Hospital, Sun Yat-sen University, Department of Gastroenterology, Guangzhou, China
A majority of patients with Crohn’s disease (CD) require an intestinal resection and will undergo reoperation for postoperative recurrence subsequently. Thiopurines (TPs) are effective in maintaining remission of CD, but data on preventing postoperative surgical recurrence are still lacking. The aim of this study was to explore the predictors associated with surgical relapse in CD patients after intestinal surgery.
We reviewed 214 patients with CD after first intestinal surgery followed-up in our Centre. Clinical data were acquired from our database. Variables associated with surgical recurrence in univariate analysis were considered for multivariate model. Cox proportional hazard model was used to identify independent risk factors for surgical recurrence. Patients then were divided into high-risk (defined as having one or more risk factors) and low-risk (without any risk factors) groups.
In total, 40 (18.7%) patients suffered a surgical recurrence after a median time of 35.5 (range 3–171) months. Before surgical relapse, 153 (71.5%) patients used TPs. On multivariate analysis, a higher risk of surgical recurrence was seen in patients with penetrating disease behaviour (compared with non-penetrating, hazard ratio [HR] 3.92; 95% confidence interval [CI] 1.48–10.39; p = 0.006), ileocolonic disease location (compared with ileal disease, HR 4.30; 95% CI 1.41–13.12; p = 0.010). Moreover, a prophylactic use of TPs after surgery dramatically reduced the risk of surgical recurrence (HR 0.06; 95% CI 0.02–0.15; p < 0.001). In the low-risk group (n = 55), there were no statistical differences of surgical recurrence between patients with and without TPs (HR = 0.01; 95% CI 0.00–170.58; p = 0.347). However, amongst the high-risk group (n = 159), the patients with TPs had a lower risk of surgical recurrence compared with those without TPs (HR = 0.07; 95% CI 0.03–0.17; p < 0.001).
Thiopurines were effective in reducing the risk of surgical recurrence amongst CD patients after intestinal resection, especially in the high-risk group. Penetrating disease behaviour and ileocolonic disease increased the risk of surgical recurrence in postoperative CD patients.