Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study
<b>Objectives:</b> The incidence of Crohn’s disease and the number of associated surgeries are increasing in Korea. This study investigated the effect of azathioprine/6-mercaptopurine (6-MP) and TNF-α antagonists on abdominal and perianal surgery in Korean patients with Crohn’s disease....
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Format: | Article |
Language: | English |
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MDPI AG
2021-12-01
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Series: | Journal of Clinical Medicine |
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Online Access: | https://www.mdpi.com/2077-0383/10/1/25 |
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doaj-3a61774d5a2843718039f547914c9375 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hee Man Kim Jin Woo Kim Hyun-Soo Kim Joo Sung Kim You Sun Kim Jae Hee Cheon Won Ho Kim Byong Duk Ye Won Moon Sung Hee Jung Young-Ho Kim Dong Soo Han |
spellingShingle |
Hee Man Kim Jin Woo Kim Hyun-Soo Kim Joo Sung Kim You Sun Kim Jae Hee Cheon Won Ho Kim Byong Duk Ye Won Moon Sung Hee Jung Young-Ho Kim Dong Soo Han Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study Journal of Clinical Medicine Crohn’s disease surgery Azathioprine TNF-α antagonist |
author_facet |
Hee Man Kim Jin Woo Kim Hyun-Soo Kim Joo Sung Kim You Sun Kim Jae Hee Cheon Won Ho Kim Byong Duk Ye Won Moon Sung Hee Jung Young-Ho Kim Dong Soo Han |
author_sort |
Hee Man Kim |
title |
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study |
title_short |
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study |
title_full |
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study |
title_fullStr |
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study |
title_full_unstemmed |
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study |
title_sort |
effect of thiopurine on potential surgical intervention in crohn’s disease in korea: results from the connect study |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-12-01 |
description |
<b>Objectives:</b> The incidence of Crohn’s disease and the number of associated surgeries are increasing in Korea. This study investigated the effect of azathioprine/6-mercaptopurine (6-MP) and TNF-α antagonists on abdominal and perianal surgery in Korean patients with Crohn’s disease. <b>Design:</b> A retrospective cohort study<b>. </b><b>Setting:</b> Data from the Crohn’s Disease Clinical Network and Cohort (CONNECT) were used. Patients with confirmed Crohn’s disease between 1982 and 2008 from 32 hospitals in the Republic of Korea were enrolled. The effect of azathioprine/6-MP on abdominal and perianal surgery was analysed using logistic regression analysis adjusting for age and sex. <b>Participants</b><b>:</b> In total, 1161 Crohn’s disease patients were included in the Republic of Korea in the surgery (<i>n</i> = 462, male = 339, female = 123) and control groups (<i>n</i> = 699, male = 484, female = 215). <b>Results:</b> In total, 1161 patients were selected, with 462 patients who underwent abdominal (<i>n</i> = 245) or perianal surgery (<i>n</i> = 217). The preoperative usage rates of azathioprine/6-MP were 18.8% and 65.1% (<i>p</i> < 0.0001) in the surgery and control groups, respectively. The preoperative usage rates of TNF-α antagonists were 7.1% and 23.3% (<i>p</i> < 0.0001) in the surgery and control groups, respectively. A multivariate analysis revealed that the preoperative use of azathioprine/6-MP had an odds ratio of 0.094 for all surgeries (95% confidence interval [CI]: 0.070–0.127, <i>p</i><i> </i><<i> </i>0.0001), 0.131 for abdominal surgery (95% CI: 397–1.599, <i>p</i><i> </i><<i> </i>0.0001), and 0.059 for perianal surgery (95% CI: 0.038–0.091, <i>p</i><i> </i><<i> </i>0.0001). The preoperative use of TNF-α antagonists had an odds ratio of 0.225 for all surgeries (95% CI: 0.151–0.335, <i>p</i><i> </i><<i> </i>0.0001), 0.403 for abdominal surgery (95% CI: 0.261–0.623, <i>p</i><i> </i><<i> </i>0.0001), and 0.064 for perianal surgery (95% CI: 0.026–0.160, <i>p</i><i> < </i>0.001). <b>Strengths of this study:</b> The study presents new evidence of the reduced risk of surgery following azathioprine use in Crohn’s disease patients. <b>Limitations of this study</b> (1) This was not a controlled prospective study. (2) There was a selection bias specific to the CONNECT cohort. (3) The combination or sequential use of azathioprine/6-MP and TNF-α antagonists was not excluded. <b>Conclusion:</b> Azathioprine/6-MP is significantly associated with a reduced risk of abdominal and perianal surgery in Korean patients with Crohn’s disease. |
topic |
Crohn’s disease surgery Azathioprine TNF-α antagonist |
url |
https://www.mdpi.com/2077-0383/10/1/25 |
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doaj-3a61774d5a2843718039f547914c93752020-12-24T00:06:57ZengMDPI AGJournal of Clinical Medicine2077-03832021-12-0110252510.3390/jcm10010025Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT StudyHee Man Kim0Jin Woo Kim1Hyun-Soo Kim2Joo Sung Kim3You Sun Kim4Jae Hee Cheon5Won Ho Kim6Byong Duk Ye7Won Moon8Sung Hee Jung9Young-Ho Kim10Dong Soo Han11Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, KoreaDepartment of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul 04551, KoreaDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, KoreaDepartment of Internal Medicine, Kosin University College of Medicine, Busan 49267, KoreaDepartment of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon 34824, KoreaDepartment of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 03181, KoreaDepartment of Internal Medicine, Hanyang University College of Medicine, Guri 11923, Korea<b>Objectives:</b> The incidence of Crohn’s disease and the number of associated surgeries are increasing in Korea. This study investigated the effect of azathioprine/6-mercaptopurine (6-MP) and TNF-α antagonists on abdominal and perianal surgery in Korean patients with Crohn’s disease. <b>Design:</b> A retrospective cohort study<b>. </b><b>Setting:</b> Data from the Crohn’s Disease Clinical Network and Cohort (CONNECT) were used. Patients with confirmed Crohn’s disease between 1982 and 2008 from 32 hospitals in the Republic of Korea were enrolled. The effect of azathioprine/6-MP on abdominal and perianal surgery was analysed using logistic regression analysis adjusting for age and sex. <b>Participants</b><b>:</b> In total, 1161 Crohn’s disease patients were included in the Republic of Korea in the surgery (<i>n</i> = 462, male = 339, female = 123) and control groups (<i>n</i> = 699, male = 484, female = 215). <b>Results:</b> In total, 1161 patients were selected, with 462 patients who underwent abdominal (<i>n</i> = 245) or perianal surgery (<i>n</i> = 217). The preoperative usage rates of azathioprine/6-MP were 18.8% and 65.1% (<i>p</i> < 0.0001) in the surgery and control groups, respectively. The preoperative usage rates of TNF-α antagonists were 7.1% and 23.3% (<i>p</i> < 0.0001) in the surgery and control groups, respectively. A multivariate analysis revealed that the preoperative use of azathioprine/6-MP had an odds ratio of 0.094 for all surgeries (95% confidence interval [CI]: 0.070–0.127, <i>p</i><i> </i><<i> </i>0.0001), 0.131 for abdominal surgery (95% CI: 397–1.599, <i>p</i><i> </i><<i> </i>0.0001), and 0.059 for perianal surgery (95% CI: 0.038–0.091, <i>p</i><i> </i><<i> </i>0.0001). The preoperative use of TNF-α antagonists had an odds ratio of 0.225 for all surgeries (95% CI: 0.151–0.335, <i>p</i><i> </i><<i> </i>0.0001), 0.403 for abdominal surgery (95% CI: 0.261–0.623, <i>p</i><i> </i><<i> </i>0.0001), and 0.064 for perianal surgery (95% CI: 0.026–0.160, <i>p</i><i> < </i>0.001). <b>Strengths of this study:</b> The study presents new evidence of the reduced risk of surgery following azathioprine use in Crohn’s disease patients. <b>Limitations of this study</b> (1) This was not a controlled prospective study. (2) There was a selection bias specific to the CONNECT cohort. (3) The combination or sequential use of azathioprine/6-MP and TNF-α antagonists was not excluded. <b>Conclusion:</b> Azathioprine/6-MP is significantly associated with a reduced risk of abdominal and perianal surgery in Korean patients with Crohn’s disease.https://www.mdpi.com/2077-0383/10/1/25Crohn’s diseasesurgeryAzathioprineTNF-α antagonist |