Use of azathioprine and 6MP in postoperative Crohn's: changing natural history or just along for the ride?

Abstract

There is currently no standard of care for the management of postoperative Crohn's disease (CD), partly because data from definitive trials are lacking. Despite the absence of such data, many experts advocate the selective use of azathioprine (AZA) or 6-mercaptopurine (6MP) in the prevention of postoperative recurrence in patients with risk factors for recurrence. In the current issue of The American Journal of Gastroenterology, Peyrin-Biroulet and colleagues quantified the efficacy of AZA/6MP in this setting by performing a meta-analysis of AZA/6MP trials. The implications of this work, both for the current management of postoperative Crohn's and the future design of clinical trials that are definitive in this group of patients, are discussed.