The effects of azathioprine/6-mercaptopurine and TNF-alpha antagonist on surgery in Korean patients with Crohn's disease from the CONNECT cohort

Abstract

Background: The complications of Crohn's disease often should be treated through surgical intervention. The risk factors of complications have been studied largely. However, there are few data about the trend of medicines against Crohn's disease around surgery in Koreans. This study was designed to investigate the association between medicines and surgery in patients with Crohn's disease retrospectively. Methods: The Crohn's Disease Clinical Network and Cohort (CONNECT) retrospective cohort was used in this study. Between 1982 and 2010, patients with confirmed Crohn's disease were enrolled. The effect of azathioprine/6-mercaptopurine (6-MP) and TNF-alpha antagonist on abdominal surgery and perianal surgery were analyzed by the logistic regression analysis adjusting age, sex, location (L), and behavior (B). Results: A total of 1376 patients (M: 973, F: 403) were selected, and 622 patients (abdominal surgery: 338, perianal surgery: 284). In 412 patients with abdominal surgery or no surgery, a multivariate analysis revealed that preoperative use of azathioprine/6-MP and TNF-alpha antagonist had an odds ratio of 0.225 (95% confidence interval [CI]: 0.127-0.398, P<0.0001) and 0.797 (95% CI: 397-1.599, P=0.522) for abdominal surgery, respectively. In 393 patients with perianal surgery or no surgery, a multivariate analysis azathioprine/6MP, and TNF-alpha antagonist, revealed that preoperative use of azathioprine/6-MP and TNF-alpha antagonist had an odds ratio of 0.148 (95% CI: 0.078-0.282, P<0.0001) and 0.239 (95% CI: 0.086-0.664, P=0.006) for perianal surgery, respectively. Conclusions: Azathioprine/6-MP is significantly associated with a reduced risk of abdominal surgery and perianal surgery, and TNFalpha antagonist is significantly associated with a reduced risk of perianal surgery in Crohn's disease.