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Thiopurines Are Associated with a Reduction in Surgical Re-resections in Patients with Crohn's Disease: A Long-term Follow-up Study in a Regional and Academic Cohort

van Loo, Ellen S. MD*,†; Vosseberg, Ninke W. MD*; van der Heide, Frans MD, PhD; Pierie, Jean-Pierre E.N. MD, PhD§,‖; van der Linde, Klaas MD; Ploeg, Rutger J. MD, PhD*; Dijkstra, Gerard MD, PhD; Nieuwenhuijs, Vincent B. MD, PhD*,**

doi: 10.1097/01.MIB.0000435758.97952.a8
Original Clinical Articles

Background: Combination therapy of thiopurines and anti–tumor necrosis factor alpha (TNF-α) antibodies is the most effective medical treatment of Crohn's disease (CD). Data on thiopurines and anti-TNF-α antibodies in preventing surgical recurrence (need for re-resection) of CD are scarce. Therefore, we analyzed which factors were involved in surgical recurrence of CD in a large cohort of patients with CD operated in a regional and a university hospital.

Methods: This is a retrospective cohort study of 567 patients who underwent surgery for CD. Clinical data and risk factors for surgical recurrence were analyzed, focusing on medical therapy and hospital type.

Results: Overall, 237 (41.8%) patients developed a surgical recurrence, after a median of 70 (2–482) months. Before surgical recurrence, 235 patients (41.4%) and 116 patients (20.5%) used thiopurines and anti-TNF-α antibodies, respectively. Multivariate analysis identified 3 independent risk factors associated with surgical recurrence of CD. A higher risk was seen in patients with colonic disease compared with patients with ileal disease (hazard ratio, 1.56; 95% confidence interval, 1.10–2.21; P = 0.012) and in patients using multiple types of medication (hazard ratio, 1.38; 95% confidence interval, 1.25–1.54; P < 0.001). However, a lower risk was seen in patients using thiopurines (hazard ratio, 0.51; 95% confidence interval, 0.34–0.77; P = 0.001).

Conclusions: Thiopurines are effective in preventing surgical recurrence of CD. The role of anti-TNF-α antibodies seems promising as well. Combination therapy of thiopurines and anti-TNF-α antibodies for prevention of surgical recurrence of CD should be studied in a randomized trial.

Article first published online 1 November 2013

*Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands;

Department of Surgery, Scheper Ziekenhuis, Emmen, the Netherlands;

Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands;

§Wenckebach Institute, Post Graduate School of Medicine, University Medical Center Groningen, Groningen, the Netherlands;

Departments of Surgery, and

Gastroenterology, Medical Center Leeuwarden, Leeuwarden, the Netherlands; and

**Department of Surgery, Isala Klinieken, Zwolle, the Netherlands.

Reprints: Ellen S. van Loo, MD, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, PO BOX 30.001, Groningen 9700 RB, the Netherlands (e-mail:

The authors have no conflicts of interest to disclose.

G. Dijkstra and V. B. Nieuwenhuijs contributed equally to this study.

Received September 17, 2013

Accepted September 17, 2013

© Crohn's & Colitis Foundation of America, Inc.
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