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Azathioprine or Ileocolic Resection for Steroid-Dependent Terminal Ileal Crohn's Disease? A Markov Analysis

Kennedy, Erin D. M.D.; Urbach, David R. M.D.; Krahn, Murray D. M.D.; Steinhart, Hillary A. M.D.; Cohen, Zane M.D.; McLeod, Robin S. M.D.
Diseases of the Colon & Rectum: December 2004
doi: 10.1007/s10350-004-0725-6
Original Contributions: PDF Only

INTRODUCTION: INTRODUCTION:The objective of this study was to determine whether initial azathioprine therapy, followed by ileocolic resection if azathioprine fails, or initial ileocolic resection without a trial of azathioprine is the preferred treatment strategy in steroid-dependent, terminal ileal Crohn's disease.

METHODS: METHODS:A Markov, decision analytic model was developed to simulate a 36-month course for a patient with steroid-dependent, terminal ileal Crohn's disease who would initially take azathioprine or have ileocolic resection. Clinically important outcomes in the model included side effects and effectiveness of azathioprine and postoperative complications, mortality, and recurrence following ileocolic resection. The probabilities and utilities for these variables were derived from previously published studies.

RESULTS: RESULTS:Initial azathioprine therapy offered a relatively small benefit of 0.45 quality-adjusted life-months over initial ileocolic resection. The model was sensitive to utility for being symptom-free on azathioprine and utility for being symptom-free postoperatively.

CONCLUSIONS: CONCLUSIONS:Initial azathioprine therapy and initial ileocolic resection are both reasonable treatment strategies in this setting. The preferred treatment strategy is highly dependent on the quality of life that can be achieved with each treatment option. Therefore, individual response and symptom control with each treatment must be strongly considered in this treatment decision.

Dr. Kennedy is supported by the Crohn's and Colitis Foundation of Canada and the Medical Research Council of Canada.

Presented as a poster at Digestive Disease Week, Orlando, Florida, May 16 to 19, 1999.

Reprints are not available.

aMount Sinai Hospital, 600 University Avenue, Room 449, Toronto ON M5G 1X5, e-mail: mcleod@mtsinai.on.ca

© The ASCRS 2004