Smoking cessation remains a major weapon in preventing postoperative clinical recurrence of Crohn’s disease, researchers say.
And the use of mercaptopurine (6-MP) has also been found to be effective in achieving this goal, although only in patients who are smokers.
The article, published in The Lancet, reported on a multicentre, double-blind, randomised controlled trial in the UK that investigated whether 6-MP could prevent or delay postoperative clinical recurrence of Crohn’s disease.
“Up to 60% of patients with Crohn’s disease need intestinal resection within the first 10 years of diagnosis, and postoperative recurrence is common,” they wrote.
The researchers found the use of MP-6 did not significantly differ from placebo for any patients other than those who continued to smoke after surgery.
“Mercaptopurine is effective in preventing postoperative clinical recurrence of Crohn’s disease, but only in patients who are smokers,” the authors concluded.
“Thus, in smokers, thiopurine treatment seems to be justified in the postoperative period, although smoking cessation should be strongly encouraged given that smoking increases the risk of recurrence.”
Prof Jane Andrews, Head IBD Service and Education at the Royal Adelaide Hospital’s Department of Gastroenterology and Hepatology said this was an “interesting study” that confirmed the view that smoking cessation was key to post-surgery recurrence.
“It’s absolutely vital,” she said. “Smoking cessation comes out again and again and again as a risk factor for recurrence.”
Professor Andrews also pointed out that the use of thiopurine drugs like 6-MP and azathioprine was more likely to be used as a maintenance agent as they were usually “too slow to get people into remission”.
And dosing by weight – as was the procedure in the UK study – had also been superseded by metabolism-based dosing, which has been pioneered in Australia in the past five years and has been the subject of a number of papers.
She said that most Australian gastroenterologists would be aware of therapeutic drug monitoring.
“Giving people a one size fits all dose according to weight is going to under-dose some and overdose others,” she told the limbic.
Professor Andrews conceded that many IBD specialists would be using 6-MP differently to what the UK study indicated, but fully supported the smoking message.
“Don’t smoke and then we don’t need to give you a toxic drug,” she said.
“Full credit to the investigators to carry out a study on this, but it’s not the standard of care we would now expect in a good teaching hospital IBD clinic.”